Provider Demographics
NPI:1982083788
Name:DIAZ, MILENA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MILENA
Middle Name:
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 1:1601 N GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807-8308
Mailing Address - Country:US
Mailing Address - Phone:407-382-8038
Mailing Address - Fax:
Practice Address - Street 1:1601 N GOLDENROD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-8308
Practice Address - Country:US
Practice Address - Phone:407-382-8038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN22828122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist