Provider Demographics
NPI:1750998878
Name:NADGIE ORTIZ DIAZ DMD PLLC
Entity type:Organization
Organization Name:NADGIE ORTIZ DIAZ DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NADGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:276-663-3126
Mailing Address - Street 1:24560 SOUTHPOINT DR STE 240
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-3505
Mailing Address - Country:US
Mailing Address - Phone:276-663-3126
Mailing Address - Fax:276-663-3121
Practice Address - Street 1:24560 SOUTHPOINT DR STE 240
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-3505
Practice Address - Country:US
Practice Address - Phone:276-663-3126
Practice Address - Fax:276-663-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty