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General NPI Number Information
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NPI Number | 1043392111
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Entity Type | Individual
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Provider Name | FEDERICO DIEZ D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 10/19/2006
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Last Update Date | 09/29/2021
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Provider Practice Location Address
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Address Line | 12600 PEMBROKE RD SUITE 314
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City | MIRAMAR
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State | FL
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Zip | 33027-2544
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Country | US
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Telephone | 954-505-7631
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Fax | 954-505-7633
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Provider Business Mailing Address
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Address Line | 4581 WESTON RD # 321
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City | WESTON
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State | FL
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Zip | 33331-3141
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Country | US
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Telephone | 305-725-3426
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Fax | 954-517-1592
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 14284
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN 14284
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License Number State | FL
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