Individual
RICHARD NELSON DIAZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
115 S CHARLES ST, CHARLES TOWN, WV 25414
(304) 725-4492
(304) 725-9700
Mailing address
2716 WOLFE DR, KNOXVILLE, MD 21758-8802
(301) 834-8781
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
84
MD
1223G0001X
General Practice Dentistry
Primary
2571
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0136653000
—
WV
Enumeration date
07/26/2006
Last updated
07/02/2018
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