Active NPI
Jesus Antonio Diaz, DDS
- Periodontics
- Hialeah, FL
National Provider Identifier
1740496892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- DN11799
- Practice address
- 7000 W 12TH Ave
Suite 6
Hialeah, FL 33014-5154 - Phone
- (305) 557-5888
- Fax
- (305) 818-6677
- NPI assigned
- May 15, 2007
- Last updated
- May 25, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | DN11799 | FL | Primary |
Addresses
Primary practice location
7000 W 12TH Ave
Suite 6
Hialeah, FL 33014-5154
Mailing address
1402 SE 17TH Ave
Homestead, FL 33035-2211
Medicare participation
Medicare enrollment files- 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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150826000674 | FL | Order and Referring Only - Oral Surgery | 7012223738 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Dentist Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Dental Clinic/Center
- Hialeah, FL
- NPI 1598409807
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179187200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621900800000",
"number": "1740496892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1402 SE 17TH AVE",
"city": "HOMESTEAD",
"state": "FL",
"postal_code": "330352211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7000 W 12TH AVE",
"address_2": "SUITE 6",
"city": "HIALEAH",
"state": "FL",
"postal_code": "330145154",
"telephone_number": "305-557-5888",
"fax_number": "305-818-6677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIAZ",
"first_name": "JESUS",
"middle_name": "ANTONIO",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-15",
"last_updated": "2021-05-25",
"certification_date": "2021-05-25",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "FL",
"license": "DN11799",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Hialeah, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2021; 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.