Provider Demographics
NPI:1770526345
Name:DIAZ, CECILIA C (DDS)
Entity type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:C
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3714 W EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-8725
Mailing Address - Country:US
Mailing Address - Phone:813-835-8900
Mailing Address - Fax:813-835-8614
Practice Address - Street 1:3714 W EUCLID AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-8725
Practice Address - Country:US
Practice Address - Phone:813-835-8900
Practice Address - Fax:813-835-8614
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-13
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL203486602OtherTAX PAYER ID NUMBER