NPI 1043481765

Martha E. Diaz D.D.S., P.C.

Organisation Preferred Provider Organization Waukegan, IL

Practice location

Address: 2634 Grand Ave Suite 207, Waukegan, IL 60085-2458
Phone: (847) 599-3855
Fax: (847) 599-3859

Authorised official

Name: Eugenio Sierra
Title: Administrator
Phone: (847) 599-3855

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X

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Registry record

NPI: 1043481765
Entity type: Organization
NPI issued: 20 Mar 2008
Record last updated: 20 Mar 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.