Provider Demographics
NPI:1750029609
Name:DIAZ KLINTCHARSKA, TANIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:TANIA
Middle Name:
Last Name:DIAZ KLINTCHARSKA
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 1:15225 SW 145TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-6816
Mailing Address - Country:US
Mailing Address - Phone:786-403-4806
Mailing Address - Fax:
Practice Address - Street 1:3850 SW 87TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-5400
Practice Address - Country:US
Practice Address - Phone:305-553-5292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN268251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice