Organization
EDUARDO DIAZ DENTAL CORPORATION
Active
Other names
EASTLAKE IMPLANT & LASER DENTISTRY
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EDUARDO DIAZ D.D.S., PC, ICOI (PRESIDENT)
(619) 216-0111
Entity
Organization
Contact information
Practice address
890 EASTLAKE PKWY, SUITE 303, CHULA VISTA, CA 91914-4520
(619) 216-0111
(619) 216-7081
Mailing address
890 EASTLAKE PKWY, SUITE 303, CHULA VISTA, CA 91914-4520
(619) 216-0111
(619) 216-7081
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
44306
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1922157288
NPI
CA
Enumeration date
05/18/2009
Last updated
08/04/2011
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