Provider Demographics
NPI:1821772641
Name:ALBERICH, DIANA MARTHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:MARTHA
Last Name:ALBERICH
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 1:482 FISHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:OPA LOCKA
Mailing Address - State:FL
Mailing Address - Zip Code:33054-3818
Mailing Address - Country:US
Mailing Address - Phone:305-687-6880
Mailing Address - Fax:
Practice Address - Street 1:482 FISHERMAN ST
Practice Address - Street 2:
Practice Address - City:OPA LOCKA
Practice Address - State:FL
Practice Address - Zip Code:33054-3818
Practice Address - Country:US
Practice Address - Phone:305-687-6880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN28449122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist