Provider Demographics
NPI:1871643312
Name:DIAZ, IVETTE (DDS)
Entity Type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:DIAZ
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 1:1901 KIRBY ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-5704
Mailing Address - Country:US
Mailing Address - Phone:713-436-8988
Mailing Address - Fax:
Practice Address - Street 1:1901 KIRBY ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5704
Practice Address - Country:US
Practice Address - Phone:713-436-8988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207981223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry