Provider Demographics
NPI:1124104575
Name:DIEGUEZ-MARINO ORTHODONTICS P C
Entity type:Organization
Organization Name:DIEGUEZ-MARINO ORTHODONTICS P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BERTHA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:DIEGUEZ-MARINO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-980-4744
Mailing Address - Street 1:2072 CAHABA CREST DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35242-4417
Mailing Address - Country:US
Mailing Address - Phone:205-980-4744
Mailing Address - Fax:
Practice Address - Street 1:2800 GREYSTONE COMMERCIAL BLVD
Practice Address - Street 2:SUITE 4-A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-2667
Practice Address - Country:US
Practice Address - Phone:205-980-4744
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL42241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty