Provider Demographics
NPI:1225521834
Name:DIAZ, DAILI (DMD)
Entity type:Individual
Prefix:DR
First Name:DAILI
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2118 ASHLEY OAKS CIR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33544-6402
Mailing Address - Country:US
Mailing Address - Phone:813-907-7545
Mailing Address - Fax:813-973-4279
Practice Address - Street 1:2118 ASHLEY OAKS CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6402
Practice Address - Country:US
Practice Address - Phone:813-907-7545
Practice Address - Fax:813-973-4279
Is Sole Proprietor?:No
Enumeration Date:2018-06-08
Last Update Date:2024-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN233661223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery