Provider Demographics
NPI:1871764035
Name:CORINA DIAZ-BAJSEL DDS PC
Entity type:Organization
Organization Name:CORINA DIAZ-BAJSEL DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIAZ-BAJSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-926-8899
Mailing Address - Street 1:5616 LAWNDALE BLVD
Mailing Address - Street 2:A-201
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77023
Mailing Address - Country:US
Mailing Address - Phone:713-923-7000
Mailing Address - Fax:
Practice Address - Street 1:5616 LAWNDALE ST
Practice Address - Street 2:A-201
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77023-3840
Practice Address - Country:US
Practice Address - Phone:713-923-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty