Michael Diaz Sr., DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30061 Issued in CA

Practice address

242 E Airport Dr Ste 100
San Bernardino, CA 92408-3408

Phone

(909) 890-0050

Fax

(909) 890-0042

NPI assigned

Jul 19, 2006

Sex

Male

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 TX

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

Locations

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.

• Northeastern Tribal Health System

  • Clinic/Center
  • Miami, OK
  • NPI 1871522532

  TX

  Medicare reassignment NPD

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1422489600000",
    "number": "1881613602",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "242 E AIRPORT DR STE 100",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083408",
            "telephone_number": "909-890-0050",
            "fax_number": "909-890-0042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "242 E AIRPORT DR STE 100",
            "city": "SAN BERNARDINO",
            "state": "CA",
            "postal_code": "924083408",
            "telephone_number": "909-890-0050",
            "fax_number": "909-890-0042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIAZ",
        "first_name": "MICHAEL",
        "name_prefix": "Mr.",
        "name_suffix": "Sr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2015-01-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "30061",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimberly Diaz
• Kristina Kay Diaz
• Luis Diaz
• Maria Trinidad Diaz, CNM
• Maricela Diaz
• Morgan Diaz
• Vivian Diaz
• Devin Dickerson
• Iman Dickerson, LVN
• Serene Dickerson

• General Practice Dentistry in San Bernardino, CA
• Providers in San Bernardino, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2015; 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.