Provider Demographics
NPI:1861591968
Name:DIAZ, MARITZA I (DMD)
Entity type:Individual
Prefix:DR
First Name:MARITZA
Middle Name:I
Last Name:DIAZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9172 LAUREL HIGHLANDS PL
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5857
Mailing Address - Country:US
Mailing Address - Phone:787-557-2704
Mailing Address - Fax:787-720-7895
Practice Address - Street 1:9110 RAILROAD DR STE 201
Practice Address - Street 2:
Practice Address - City:MANASSAS PARK
Practice Address - State:VA
Practice Address - Zip Code:20111-7041
Practice Address - Country:US
Practice Address - Phone:703-365-0230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401411863122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist