Provider Demographics
NPI:1770831315
Name:RICO ROJAS, DIANA MARIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARIA
Last Name:RICO ROJAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 SW 44TH WAY
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8257
Mailing Address - Country:US
Mailing Address - Phone:561-503-7046
Mailing Address - Fax:
Practice Address - Street 1:1105 SW 44TH WAY
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-8257
Practice Address - Country:US
Practice Address - Phone:561-503-7046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-28
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 199001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice