Provider Demographics
NPI:1255352142
Name:OSPINA, DIEGO L (DMD)
Entity type:Individual
Prefix:DR
First Name:DIEGO
Middle Name:L
Last Name:OSPINA
Suffix:
Gender:M
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:PO BOX 130
Mailing Address - Street 2:
Mailing Address - City:OSTEEN
Mailing Address - State:FL
Mailing Address - Zip Code:32764-0030
Mailing Address - Country:US
Mailing Address - Phone:407-894-3571
Mailing Address - Fax:407-895-5511
Practice Address - Street 1:5030 SR 46 STE 108
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-9247
Practice Address - Country:US
Practice Address - Phone:407-894-3571
Practice Address - Fax:407-895-5511
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL164121223G0001X
FLDN16412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice