=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265943138
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ESMERALDA DIAZ MARCANTEL DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2017
-----------------------------------------------------
Last Update Date | 06/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4540 SPRING STUEBNER RD SUITE 500
-----------------------------------------------------
City | SPRING
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77022-1624
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-692-1388
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6215 ROSEHILL HARVEST LOOP
-----------------------------------------------------
City | KATY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77493
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-501-5167
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 39635
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------