Provider Demographics
NPI:1245457183
Name:BUSCIGLIO DIAZ, DANA M (DMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:BUSCIGLIO DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5601 SKYTOP DR
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547-4165
Mailing Address - Country:US
Mailing Address - Phone:813-603-8800
Mailing Address - Fax:813-603-8801
Practice Address - Street 1:5601 SKYTOP DR
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547
Practice Address - Country:US
Practice Address - Phone:813-603-8800
Practice Address - Fax:813-603-8801
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 16945122300000X
FLDN169451223X0400X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics