MEDICARE: CORINA DIAZ-BAJSEL DDS PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1871764035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORINA DIAZ-BAJSEL DDS PC

Provider Business Mailing Address
First Line	:	5616 LAWNDALE BLVD
Second Line	:	A-201
City	:	HOUSTON
State	:	TX
Zip	:	77023
Country	:	US
Telephone Number	:	713-923-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	5616 LAWNDALE ST
Second Line	:	A-201
City	:	HOUSTON
State	:	TX
Zip	:	77023-3840
Country	:	US
Telephone Number	:	713-923-7000
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CORINA DIAZ-BAJSEL
Credential	:	DDS
Telephone Number	:	713-926-8899

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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