Individual
ELIANET DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
12456 STATE ROAD 54, ODESSA, FL 33556-3477
(217) 540-5100
Mailing address
12456 STATE ROAD 54, ODESSA, FL 33556-3477
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN22792
FL
Other
Enumeration date
07/12/2017
Last updated
07/12/2017
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