Provider Demographics
NPI:1972118834
Name:DIAZ, BELEN PATRICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:BELEN
Middle Name:PATRICIA
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 1:2900 W DALLAS ST APT 508
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77019-4281
Mailing Address - Country:US
Mailing Address - Phone:956-429-9497
Mailing Address - Fax:
Practice Address - Street 1:2922 N MASON RD # 140
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-5456
Practice Address - Country:US
Practice Address - Phone:832-321-5761
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX366661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice