Provider Demographics
NPI:1740651512
Name:DR LIDIA M PAZ DOS PA
Entity type:Organization
Organization Name:DR LIDIA M PAZ DOS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIDIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-247-5264
Mailing Address - Street 1:950 N KROME AVE
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33030-4400
Mailing Address - Country:US
Mailing Address - Phone:305-247-5264
Mailing Address - Fax:305-247-8361
Practice Address - Street 1:950 N KROME AVE
Practice Address - Street 2:SUITE # 207
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4400
Practice Address - Country:US
Practice Address - Phone:305-247-5264
Practice Address - Fax:305-247-8361
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-19
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL17927122300000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Single Specialty