Provider Demographics
NPI:1043309057
Name:MERCEDES AYBAR-DIAZ, DDS, PA
Entity type:Organization
Organization Name:MERCEDES AYBAR-DIAZ, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:919-431-9111
Mailing Address - Street 1:6308 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-6807
Mailing Address - Country:US
Mailing Address - Phone:919-431-9111
Mailing Address - Fax:919-431-9155
Practice Address - Street 1:6308 FALLS OF NEUSE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-6807
Practice Address - Country:US
Practice Address - Phone:919-431-9111
Practice Address - Fax:919-431-9155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC90173OtherNC HEALTHCHOISE