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General NPI Number Information
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NPI Number | 1255352142
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Entity Type | Individual
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Provider Name | DIEGO L OSPINA DMD
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Gender | Male
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Dates
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Enumeration Date | 07/23/2006
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 5030 SR 46 STE 108
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City | SANFORD
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State | FL
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Zip | 32771-9247
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Country | US
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Telephone | 407-894-3571
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Fax | 407-895-5511
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Provider Business Mailing Address
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Address Line | PO BOX 130
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City | OSTEEN
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State | FL
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Zip | 32764-0030
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Country | US
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Telephone | 407-894-3571
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Fax | 407-895-5511
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 16412
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN16412
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License Number State | FL
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