Provider Demographics
NPI:1689244204
Name:VALDES DIAZ, ALISMEI (DMD)
Entity Type:Individual
Prefix:
First Name:ALISMEI
Middle Name:
Last Name:VALDES DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 N HOMESTEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-5024
Mailing Address - Country:US
Mailing Address - Phone:786-410-6656
Mailing Address - Fax:
Practice Address - Street 1:23250 SW 152ND AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33032-2002
Practice Address - Country:US
Practice Address - Phone:786-350-6751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-27
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL260961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice