NPI 1114139540

Martha E Diaz, DDS

Practitioner General Practice Dentistry Waukegan, IL

Practice location

Address: 1611 Grand Ave, Waukegan, IL 60085-3605
Phone: (847) 599-3855
Fax: (847) 599-3859

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 019.026605 (IL)

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Registry record

NPI: 1114139540
Entity type: Individual
Sex (as registered): Female
NPI issued: 6 May 2007
Record last updated: 26 Jul 2019

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.