Provider Demographics
NPI:1891531414
Name:DIAZ, DANIEL S (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:S
Last Name:DIAZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19400 NW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6214
Mailing Address - Country:US
Mailing Address - Phone:786-246-5723
Mailing Address - Fax:
Practice Address - Street 1:280 INDIAN TRCE STE A
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-4509
Practice Address - Country:US
Practice Address - Phone:954-248-2895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2025-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1102621223G0001X
FLDN29918122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice