Provider Demographics
NPI:1841279809
Name:DE LA PAZ, ED (DMD)
Entity type:Individual
Prefix:
First Name:ED
Middle Name:
Last Name:DE LA PAZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9710 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
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN126771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice