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General NPI Number Information
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NPI Number | 1205185410
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Entity Type | Organization
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Legal Business Name | OSMANI DIAZ DDS PA
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Dates
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Enumeration Date | 09/04/2012
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Last Update Date | 09/04/2012
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Provider Practice Location Address
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Address Line | 650 NW 180TH TER STE 103
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2825
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Country | US
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Telephone | 954-437-9288
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Fax | 954-437-7929
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Provider Business Mailing Address
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Address Line | 650 NW 180TH TER STE 103
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-2825
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Country | US
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Telephone | 954-437-9288
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Fax | 954-437-7929
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. JOSEFINA DIAZ
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Credential |
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Telephone | 954-437-9288
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN12310
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License Number State | FL
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