Provider Demographics
NPI:1770869810
Name:ED DE LA PAZ, D.M.D., P.A.
Entity type:Organization
Organization Name:ED DE LA PAZ, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ED
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA PAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-930-8300
Mailing Address - Street 1:9710 N ARMENIA AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7507
Mailing Address - Country:US
Mailing Address - Phone:813-930-8300
Mailing Address - Fax:813-915-1501
Practice Address - Street 1:9710 N ARMENIA AVE
Practice Address - Street 2:SUITE D
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7507
Practice Address - Country:US
Practice Address - Phone:813-930-8300
Practice Address - Fax:813-915-1501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12677261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental