MEDICARE: MERCEDES AYBAR-DIAZ, DDS, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	7247	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	90173	OTHER	NC	NC HEALTHCHOISE

General Provider Information

NPI Number	:	1043309057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERCEDES AYBAR-DIAZ, DDS, PA

Provider Business Mailing Address
First Line	:	6308 FALLS OF NEUSE RD
Second Line	:	SUITE 400
City	:	RALEIGH
State	:	NC
Zip	:	27615-6807
Country	:	US
Telephone Number	:	919-431-9111
Fax Number	:	919-431-9155

Provider Business Practice Location Address
First Line	:	6308 FALLS OF NEUSE RD
Second Line	:	SUITE 400
City	:	RALEIGH
State	:	NC
Zip	:	27615-6807
Country	:	US
Telephone Number	:	919-431-9111
Fax Number	:	919-431-9155

Authorized Official
Title or Position	:	BUSINESS ADMINISTRATOR
Name	:	DR. OSCAR DIAZ JR.
Credential	:
Telephone Number	:	919-431-9111

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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