Healthcare Provider Details

I. General information

NPI: 1417881277
Provider Name (Legal Business Name): CHRISTIAN CONCEPCION DIAZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CHRISTIAN DIAZ DMD

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3710 ALOMA AVE
WINTER PARK FL
32792-9362
US

IV. Provider business mailing address

111 EAGLE EDGE LN APT 203
WINTER SPRINGS FL
32708-6568
US

V. Phone/Fax

Practice location:
  • Phone: 407-678-8848
  • Fax:
Mailing address:
  • Phone: 305-546-5202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31812
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN31812
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: