Provider Demographics
NPI:1679659619
Name:AYBAR-DIAZ, MERCEDES (DDS)
Entity type:Individual
Prefix:DR
First Name:MERCEDES
Middle Name:
Last Name:AYBAR-DIAZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7247122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist