Provider Demographics
NPI:1679770440
Name:DIAZ JIMENEZ, DANIEL DIONISIO (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:DIONISIO
Last Name:DIAZ JIMENEZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:D
Other - Last Name:DIAZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 810119
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00981-0119
Mailing Address - Country:US
Mailing Address - Phone:787-273-0918
Mailing Address - Fax:787-273-0918
Practice Address - Street 1:AVE PONCE DE LEON 123 BO AMELIA
Practice Address - Street 2:
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00965
Practice Address - Country:US
Practice Address - Phone:787-273-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27491223G0001X, 261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No1223G0001XDental ProvidersDentistGeneral Practice