Provider Demographics
NPI:1710949201
Name:DIAZ, ERNIE PEDRO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNIE
Middle Name:PEDRO
Last Name:DIAZ
Suffix:
Gender:M
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:PO BOX 9147
Mailing Address - Street 2:PLAZA CAROLINA STATION
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00988-9147
Mailing Address - Country:US
Mailing Address - Phone:787-752-4950
Mailing Address - Fax:787-257-3880
Practice Address - Street 1:4LS12 VIA LETICIA
Practice Address - Street 2:VILLA FONTANA
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00983-4823
Practice Address - Country:US
Practice Address - Phone:787-752-4950
Practice Address - Fax:787-257-3880
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PRD07731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice