Provider Demographics
NPI:1942597760
Name:MACIAS DIAZ, KARLA V (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARLA
Middle Name:V
Last Name:MACIAS 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 1:75 S FAIR MANOR CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-1085
Mailing Address - Country:US
Mailing Address - Phone:402-850-9697
Mailing Address - Fax:
Practice Address - Street 1:8008 ASHLANE WAY STE 150
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2107
Practice Address - Country:US
Practice Address - Phone:281-419-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6973122300000X
TX27891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist