Healthcare Provider Details

I. General information

NPI: 1851773675
Provider Name (Legal Business Name): FRANQUIL NELSON DIAZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104C ADAIR DR
GOLDSBORO NC
27530-4516
US

IV. Provider business mailing address

201 MOORE ST
CLAYTON NC
27520-2217
US

V. Phone/Fax

Practice location:
  • Phone: 919-648-4437
  • Fax:
Mailing address:
  • Phone: 919-360-3524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10094
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: