Provider Demographics
NPI:1740900588
Name:DIAZ, ROSALIND IVETTE (DMD)
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:IVETTE
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7169 VIA FIRENZE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-1044
Mailing Address - Country:US
Mailing Address - Phone:561-715-7118
Mailing Address - Fax:
Practice Address - Street 1:7169 VIA FIRENZE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-1044
Practice Address - Country:US
Practice Address - Phone:561-715-7118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL135191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice