Healthcare Provider Details

I. General information

NPI: 1013272830
Provider Name (Legal Business Name): DR. ANGEL DIAZ-NORRMAN, D.D.S., PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2012
Last Update Date: 07/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9100 CORAL WAY SUITE 2
MIAMI FL
33165-2076
US

IV. Provider business mailing address

9100 CORAL WAY SUITE 2
MIAMI FL
33165-2066
US

V. Phone/Fax

Practice location:
  • Phone: 305-227-4020
  • Fax: 305-223-0355
Mailing address:
  • Phone: 305-227-4020
  • Fax: 305-223-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDN11852
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDN11057
License Number StateFL

VIII. Authorized Official

Name: DR. ANGEL DIAZ-NORRMAN
Title or Position: OWNER/PERIODONTIST
Credential: D.D.S.
Phone: 305-227-4020