Vanessa Melissa Diaz, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

DN26051 Issued in FL

Practice address

921 SE 17TH St Ste C
Fort Lauderdale, FL 33316-3000

Phone

(954) 335-6716

NPI assigned

Jul 8, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Dentists of Pines, PA

  dba Dentists of Pines

  • Dentist
  • Pembroke Pines, FL
  • NPI 1972093904
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1625702400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706486400000",
    "number": "1356912562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 NW 24TH AVE APT 412",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331251236",
            "telephone_number": "786-546-0552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 SE 17TH ST STE C",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333163000",
            "telephone_number": "954-335-6716"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "VANESSA",
        "middle_name": "MELISSA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-07-08",
        "last_updated": "2024-01-29",
        "certification_date": "2024-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN26051",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bertha Diaz
• Jason Lee Diaz, PA-C
• Jose Juan Diaz, DO
• Maira Diaz
• Tatiana Diaz
• Vanessa S Dibucci
• Timothy John Dickhudt, M.D.
• Erin Dickinson, APRN, FNP-BC
• Lauren Dickson, MSN, APRN, FNP-BC
• Raina Diedrick, PHYSICIAN ASSISTANT

• Dentist in Fort Lauderdale, FL
• Providers in Fort Lauderdale, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.