Provider Demographics
NPI:1205926771
Name:BUENO DIAZ, LAURA V (DDS)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:V
Last Name:BUENO DIAZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9995 SW 72ND ST
Mailing Address - Street 2:SUITE # 207
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4662
Mailing Address - Country:US
Mailing Address - Phone:305-596-2335
Mailing Address - Fax:305-596-6938
Practice Address - Street 1:9995 SW 72ND ST
Practice Address - Street 2:SUITE # 207
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-4662
Practice Address - Country:US
Practice Address - Phone:305-596-2335
Practice Address - Fax:305-596-6938
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00126601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice