Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
ALACHUA COUNTY
DENTIST
#RHC010936
Acorn Clinic
23320 N. State Rd, Ste 235
Brooker, FL 32622
(352) 485-2772
Special Needs: Yes
Gujarati, English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN8024 Aguirre, Michael
NPI: 1740388800 LIC: DN8024
CERTIFICATIONS :
# DN18987 Bhakta, Paayal
NPI: 1033439823 LIC: DN18987
CERTIFICATIONS :
# DN9374 Hsiung, Edwin
NPI: 1417389586 LIC: DN9374
CERTIFICATIONS :
# DN21295 Luaces, Olga
NPI: 1407237555 LIC: DN21295
CERTIFICATIONS :
# DN6188 Witt, William
NPI: 1417987967 LIC: DN6188
CERTIFICATIONS :
#010980
Affordable Dentures - Gainesville,
P.A.
9200 Nw 39Th Ave, Ste 200
Gainesville, FL 32606
(352) 376-8229
Special Needs: Yes
English
M-T 7am-4pm
W-F 7am-4pm
# DN6996 Showstark, Stephan*
NPI: 1639266562 LIC: DN6996
CERTIFICATIONS :
# DN6188 Witt, William*
NPI: 1417987967 LIC: DN6188
CERTIFICATIONS :
#FQHC010440
Azalea Health
410 Ne Waldo Road
Gainesville, FL 32641
(352) 375-3790
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21424 Budzinski, Volha
NPI: 1588047468 LIC: DN21424
CERTIFICATIONS :
# DN15770 Halady, Pratima
NPI: 1720256811 LIC: DN15770
CERTIFICATIONS :
# HAD56 Krotzinger, Mary
NPI: 1992796973 LIC: HAD56
CERTIFICATIONS :
# DN20873 Lopez, Melvin
NPI: 1689081242 LIC: DN20873
CERTIFICATIONS :
# DN12941 Pairot, Alfredo
NPI: 1932174448 LIC: DN12941
CERTIFICATIONS :
# DN8746 Saraga, David
NPI: 1780805028 LIC: DN8746
CERTIFICATIONS :
#CHC014623
DOH - Alachua County Health
Department
816 Sw 64Th Terrance
Gainesville, FL 32607
(352) 334-8839
Special Needs: Yes
English, Russian, Bulgarian, German,
Italian, Spanish
W 8am-5pm,
# DN18987 Bhakta, Paayal*
NPI: 1033439823 LIC: DN18987
CERTIFICATIONS :
# DN19484 Jones, Stephanie*
NPI: 1548549678 LIC: DN19484
CERTIFICATIONS :
# DN21933 Vu, Clara*
NPI: 1235589482 LIC: DN21933
CERTIFICATIONS :
• Inhalation Sedation
# DN18661 Whitford, Drew*
NPI: 1851527303 LIC: DN18661
CERTIFICATIONS :
• Inhalation Sedation
#CHC017031
DOH - Alachua County Health
Department
224 Se 24Th St
Gainesville, FL 32641
(352) 334-8839
Special Needs: Yes
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
# DN19484 Jones, Stephanie*
NPI: 1548549678 LIC: DN19484
CERTIFICATIONS :
# DN21933 Vu, Clara*
NPI: 1235589482 LIC: DN21933
CERTIFICATIONS :
• Inhalation Sedation
# DN18661 Whitford, Drew*
NPI: 1851527303 LIC: DN18661
CERTIFICATIONS :
• Inhalation Sedation
#010934
Edwin F. Johary, DDS
1831 Nw 13Th Street, Ste #4
Gainesville, FL 32609
(352) 377-0360
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN15990 Johary, Edwin*
NPI: 1609916899 LIC: DN15990
CERTIFICATIONS :
• Inhalation Sedation
#011246
Gainesville Dental Center
4000 West Newberry Road, Ste E
Gainesville, FL 32607
(352) 378-3131
Special Needs: Yes
English, Arabic
M-T 9am-5pm
W 9am-5pm,
# DN9531 Attia, Safwat*
NPI: 1952311730 LIC: DN9531
CERTIFICATIONS :
#010755
University of Florida College of
Dentistry
1600 Sw Archer Road
Gainesville, FL 32610
www.dental.ufl.edu
(352) 273-6820
Special Needs: Yes
English, Other
M-T 8am-5pm
W-F 8am-5pm
# DN14714 Barnes, David
NPI: 1467667451 LIC: DN14714
CERTIFICATIONS :
# DN7077 Benjamin, Paul
NPI: 1225057128 LIC: DN7077
CERTIFICATIONS :
# DTP675 Camargo, Carlos
NPI: 1518459312 LIC: DTP675
CERTIFICATIONS :
# DTP657 Cassiano, Luisa
NPI: 1295281335 LIC: DTP657
CERTIFICATIONS :
# DN8382 Cook, Larry
NPI: 1902813777 LIC: DN8382
CERTIFICATIONS :
# DTP630 Delgado Caraballo, Maria
NPI: 1003274002 LIC: DTP630
CERTIFICATIONS :
# DTP603 Delgado, Alejandro
NPI: 1669887485 LIC: DTP603
CERTIFICATIONS :
# DTP639 Dias Ribeiro, Ana
NPI: 1053860924 LIC: DTP639
CERTIFICATIONS :
# DN13471 Dilbone, Deborah
NPI: 1104882497 LIC: DN13471
CERTIFICATIONS :
# DN16318 Djuric, Amira
NPI: 1033291471 LIC: DN16318
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 1 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN8807 Garvey, Timothy
NPI: 1205892296 LIC: DN8807
CERTIFICATIONS :
# DTP400 Gibbs, Micaela
NPI: 1902862469 LIC: DTP400
CERTIFICATIONS :
# DTP680 Guha, Upoma
NPI: 1184153132 LIC: DTP680
CERTIFICATIONS :
# DN7710 Haddix, James
NPI: 1336105709 LIC: DN7710
CERTIFICATIONS :
# DTP672 Haddock, Fernando
NPI: 1477531234 LIC: DTP672
CERTIFICATIONS :
# DTP679 Hansen, Matthew
NPI: 1598008153 LIC: DTP679
CERTIFICATIONS :
# DN9870 Kaleel, Nicholas
NPI: 1447258991 LIC: DN9870
CERTIFICATIONS :
# DTP604 Kashtwari, Deeba
NPI: 1669880407 LIC: DTP604
CERTIFICATIONS :
# DN21295 Luaces, Olga
NPI: 1407237555 LIC: DN21295
CERTIFICATIONS :
# DTP659 Migliorati, Cesar
NPI: 1992810519 LIC: DTP659
CERTIFICATIONS :
• Inhalation Sedation
# DTP497 Nascimento, Marcelle
NPI: 1275706426 LIC: DTP497
CERTIFICATIONS :
# DTP702 Oliveira, Dayane
NPI: 1487204178 LIC: DTP702
CERTIFICATIONS :
# DN8944 Ottenga, Marc
NPI: 1306802293 LIC: DN8944
CERTIFICATIONS :
• Inhalation Sedation
# DTP612 Pereira, Patricia
NPI: 1437535218 LIC: DTP612
CERTIFICATIONS :
# DTP683 Reis, Andre
NPI: 1891278768 LIC: DTP683
CERTIFICATIONS :
# DN14930 Rey, Rosalia
NPI: 1346341443 LIC: DN14930
CERTIFICATIONS :
# DTP490 Ribeiro-DaSilva, Margarete
NPI: 1326228321 LIC: DTP490
CERTIFICATIONS :
# DTP562 Roulet, Jean-Francois
NPI: 1831539816 LIC: DTP562
CERTIFICATIONS :
# DTP623 Ruprecht, Axel
NPI: 1699763631 LIC: DTP623
CERTIFICATIONS :
# DTP669 Sikand, Rebecca
NPI: 1942654546 LIC: DTP669
CERTIFICATIONS :
# DTP645 Silva, Maria
NPI: 1932452547 LIC: DTP645
CERTIFICATIONS :
# DTP652 Soto, Annetty
NPI: 1780024315 LIC: DTP652
CERTIFICATIONS :
# DTP458 Tomar, Scott
NPI: 1487606950 LIC: DTP458
CERTIFICATIONS :
ENDODONTICS
# DTP654 Bakiri, Eleonora
NPI: 1952834418 LIC: DTP654
CERTIFICATIONS :
# DTP700 Marchesan, Melissa
NPI: 1427359678 LIC: DTP700
CERTIFICATIONS :
# DTP450 Pileggi, Roberta
NPI: 1356393821 LIC: DTP450
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DTP701 Vieira Ozorio, Jose
NPI: 1588111710 LIC: DTP701
CERTIFICATIONS :
ORAL SURGEON
# DN9991 Bowers, Thomas
NPI: 1851340426 LIC: DN9991
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DTP232 Dolwick, Melvin
NPI: 1659337590 LIC: DTP232
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DTP664 Freburg-Hoffmeister,
Danielle
NPI: 1447545132 LIC: DTP664
CERTIFICATIONS :
• Inhalation Sedation
# DTP709 Gohel, Anita
NPI: 1841563947 LIC: DTP709
CERTIFICATIONS :
# DN19786 Hamrick, Clayton
NPI: 1548523665 LIC: DN19786
CERTIFICATIONS :
# DN12910 Hardeman, John
NPI: 1447343918 LIC: DN12910
CERTIFICATIONS :
• Board Certification
• General Anesthesia
• Inhalation Sedation
PEDIATRIC DENTISTRY
#RHC010936
Acorn Clinic
23320 N. State Rd, Ste 235
Brooker, FL 32622
(352) 485-2772
Special Needs: Yes
Gujarati, English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DTP267 Jerrell, Roy
NPI: 1932159803 LIC: DTP267
CERTIFICATIONS :
PERIODONTICS
#010755
University of Florida College of
Dentistry
1600 Sw Archer Road
Gainesville, FL 32610
www.dental.ufl.edu
(352) 273-6820
Special Needs: Yes
English, Other
M-T 8am-5pm
W-F 8am-5pm
# DTP606 Chang, Jia
NPI: 1871862029 LIC: DTP606
CERTIFICATIONS :
# DTP687 Duarte Reis, Poliana
NPI: 1619448677 LIC: DTP687
CERTIFICATIONS :
# DTP638 Duarte, Wagner
NPI: 1407305022 LIC: DTP638
CERTIFICATIONS :
# DTP537 Neiva, Rodrigo
NPI: 1457485229 LIC: DTP537
CERTIFICATIONS :
# DN21876 Schey, Karin
NPI: 1285086173 LIC: DN21876
CERTIFICATIONS :
# DTP690 Tanaka, Tsuyoshi
NPI: 1407208853 LIC: DTP690
CERTIFICATIONS :
PROSTHODONTICS
# DTP390 Echeto, Luisa
NPI: 1144286386 LIC: DTP390
CERTIFICATIONS :
# DTP467 Esquivel-Upshaw,
Josephine
NPI: 1760495527 LIC: DTP467
CERTIFICATIONS :
# DTP439 O'Neill, Edgar
NPI: 1235195413 LIC: DTP439
CERTIFICATIONS :
BAY COUNTY
DENTIST
#010672
Eric R. Claussen D.M.D., P.A.
2624 Jenks Ave
Panama City, FL 32405
(850) 215-0798
Special Needs: Yes
English
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 2 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
M-T 8am-5pm
W-F 8am-5pm
# DN17200 Fleigel III, Jeffrey*
NPI: 1336357748 LIC: DN17200
CERTIFICATIONS :
• Board Certification
#FQHC022012
PanCare of Florida
12427 Hwy 231
Youngstown, FL 32466
(850) 215-3575
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# DN23419 Lindsay, Sean
NPI: 1477046290 LIC: DN23419
CERTIFICATIONS :
# DN21740 Moffa, Michelle
NPI: 1841277407 LIC: DN21740
CERTIFICATIONS :
# DN19745 Norton, Andrew
NPI: 1861754020 LIC: DN19745
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# DN18668 Van Dyke, Kanyaratana
NPI: 1003122656 LIC: DN18668
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
#FQHC010683
PanCare of Florida, Inc.
403 E. 11Th St
Panama City, FL 32401
(850) 767-3350
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# DN23419 Lindsay, Sean
NPI: 1477046290 LIC: DN23419
CERTIFICATIONS :
# DN21740 Moffa, Michelle
NPI: 1841277407 LIC: DN21740
CERTIFICATIONS :
# DN19745 Norton, Andrew
NPI: 1861754020 LIC: DN19745
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# DN23084 Santos, Iris
NPI: 1487875233 LIC: DN23084
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# DN18668 Van Dyke, Kanyaratana
NPI: 1003122656 LIC: DN18668
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
ENDODONTICS
#FQHC022012
PanCare of Florida
12427 Hwy 231
Youngstown, FL 32466
(850) 215-3575
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
#FQHC010683
PanCare of Florida, Inc.
403 E. 11Th St
Panama City, FL 32401
(850) 767-3350
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 5pm
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
ORAL SURGEON
#010672
Eric R. Claussen D.M.D., P.A.
2624 Jenks Ave
Panama City, FL 32405
(850) 215-0798
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN17080 Claussen, Eric
NPI: 1194983965 LIC: DN17080
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN23806 Long, Larry
NPI: 1275527137 LIC: DN23806
CERTIFICATIONS :
BREVARD COUNTY
DENTIST
#FQHC011681
Brevard Health Alliance
2120 Sarno Rd
Melbourne, FL 32935
(321) 241-6800
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD82 Alongi, Jennifer
NPI: 1306139019 LIC: HAD82
CERTIFICATIONS :
• Inhalation Sedation
# DN14021 Cheshire, Gregory
NPI: 1952303059 LIC: DN14021
CERTIFICATIONS :
• Inhalation Sedation
# DN21925 Eley, Joel
NPI: 1326491093 LIC: DN21925
CERTIFICATIONS :
• Inhalation Sedation
# DN9369 Estes, Philip
NPI: 1255766937 LIC: DN9369
CERTIFICATIONS :
• Inhalation Sedation
# DN13760 Hachmeister, Kevin
NPI: 1811922966 LIC: DN13760
CERTIFICATIONS :
# DN20658 Smith, Ross
NPI: 1245626811 LIC: DN20658
CERTIFICATIONS :
• Inhalation Sedation
#FQHC011682
Brevard Health Alliance
220 Barton Blvd, Unit C14
Rockledge, FL 32955
(321) 639-5177
Special Needs: Yes
English, Spanish
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 3 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
M-T 8am-7pm
W-Th 8am-7pm
# HAD82 Alongi, Jennifer*
NPI: 1306139019 LIC: HAD82
CERTIFICATIONS :
• Inhalation Sedation
# DN14021 Cheshire, Gregory*
NPI: 1952303059 LIC: DN14021
CERTIFICATIONS :
• Inhalation Sedation
# DN21925 Eley, Joel*
NPI: 1326491093 LIC: DN21925
CERTIFICATIONS :
• Inhalation Sedation
# DN9369 Estes, Philip*
NPI: 1255766937 LIC: DN9369
CERTIFICATIONS :
• Inhalation Sedation
# DN13760 Hachmeister, Kevin*
NPI: 1811922966 LIC: DN13760
CERTIFICATIONS :
# DN20658 Smith, Ross*
NPI: 1245626811 LIC: DN20658
CERTIFICATIONS :
• Inhalation Sedation
#FQHC016241
Brevard Health Alliance
7227 N. Us Hwy 1
Cocoa, FL 32927
(321) 877-2740
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD82 Alongi, Jennifer
NPI: 1306139019 LIC: HAD82
CERTIFICATIONS :
• Inhalation Sedation
# DN14021 Cheshire, Gregory
NPI: 1952303059 LIC: DN14021
CERTIFICATIONS :
• Inhalation Sedation
# DN21925 Eley, Joel
NPI: 1326491093 LIC: DN21925
CERTIFICATIONS :
• Inhalation Sedation
# DN9369 Estes, Philip
NPI: 1255766937 LIC: DN9369
CERTIFICATIONS :
• Inhalation Sedation
# DN13760 Hachmeister, Kevin
NPI: 1811922966 LIC: DN13760
CERTIFICATIONS :
# DN20658 Smith, Ross
NPI: 1245626811 LIC: DN20658
CERTIFICATIONS :
• Inhalation Sedation
#011378
Diane P Jones, DMD, PA
4670 Lipscomb Street Ne, Ste 13
Palm Bay, FL 32905
(321) 724-1343
Special Needs: No
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN10077 Jones, Diane*
NPI: 1699893651 LIC: DN10077
CERTIFICATIONS :
#CHC015259
DOH - Brevard County Health
Department
2555 Judge Fran Jamieson Way
Viera, FL 32940
(321) 639-5801
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W 8am-5pm,
# DN9634 Humphrey, Willie
NPI: 1225190184 LIC: DN9634
CERTIFICATIONS :
# DN17682 Klair, Kelly
NPI: 1205033222 LIC: DN17682
CERTIFICATIONS :
# DN21014 Nagaraju, Champaka
NPI: 1659769891 LIC: DN21014
CERTIFICATIONS :
# DN11385 Traul Jr., Robert
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
#CHC015260
DOH - Brevard County Health
Department
611 N. Singleton Ave
Titusville, FL 32796
(321) 637-7300
Special Needs: Yes
English, Spanish
W-Th 8am-5pm
# DN9634 Humphrey, Willie
NPI: 1225190184 LIC: DN9634
CERTIFICATIONS :
# DN17682 Klair, Kelly
NPI: 1205033222 LIC: DN17682
CERTIFICATIONS :
# DN21014 Nagaraju, Champaka
NPI: 1659769891 LIC: DN21014
CERTIFICATIONS :
# DN11385 Traul Jr., Robert
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
#022718
Quality Dentures, LLC
313 N. Babcock Street
Melbourne, FL 32935
(321) 259-1949
Special Needs: No
English
T 8am - 4pm
W-Th 8am-4pm
# DN10444 Bell, E. Scott
NPI: 1093725558 LIC: DN10444
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#CHC015259
DOH - Brevard County Health
Department
2555 Judge Fran Jamieson Way
Viera, FL 32940
(321) 639-5801
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W 8am-5pm,
# HAD31 Cunnion, Dara
NPI: 1427128727 LIC: HAD31
CERTIFICATIONS :
• Board Certification
#CHC015260
DOH - Brevard County Health
Department
611 N. Singleton Ave
Titusville, FL 32796
(321) 637-7300
Special Needs: Yes
English, Spanish
W-Th 8am-5pm
# HAD31 Cunnion, Dara
NPI: 1427128727 LIC: HAD31
CERTIFICATIONS :
• Board Certification
BROWARD COUNTY
DENTIST
#008934
Ahmad Ahmadi D.M.D., PA
12311 Taft Street Ste 2
Pembroke Pines, FL 33026
www.pearlywhitesmiles.fl.com
(954) 430-5700
Special Needs: Yes
English, Spanish, Persian
T 8am - 2pm
S 8am - 2pm
# DN16261 Ahmadi, Ahmad
NPI: 1538275292 LIC: DN16261
CERTIFICATIONS :
#008935
Ahmad Ahmadi D.M.D., PA
6656 Parkside Drive
Parkland, FL 33067
www.pearlywhitesmiles.fl.com
(954) 752-8283
Special Needs: Yes
English, Spanish, Persian
M 8am - 2pm,
W 8am-2pm,
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 4 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
S 8am - 2pm
# DN16261 Ahmadi, Ahmad
NPI: 1538275292 LIC: DN16261
CERTIFICATIONS :
#013157
All Care Dental
3207 North State Road 7, Ste 24
Margate, FL 33063
(954) 979-1357
Special Needs: Yes
English, Spanish, Portuguese
M 10am - 3pm, T 9am - 5pm
W 9am-5pm, Th 9am-7pm,F
10am-12pm
# DN16620 Yeoshoua, Oded
NPI: 1396969507 LIC: DN16620
CERTIFICATIONS :
#022277
Allure Dental of Plantation PLLC
1945 N Pine Island Road
Fort Lauderdale, FL 33322
(954) 473-9161
Special Needs: Yes
English, Russian, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN20596 Coyle, Sean
NPI: 1962814632 LIC: DN20596
CERTIFICATIONS :
# DN20696 Kopynets, Viktor
NPI: 1932517042 LIC: DN20696
CERTIFICATIONS :
• Inhalation Sedation
# DN12167 Kuntsmann, Vivian
NPI: 1104995539 LIC: DN12167
CERTIFICATIONS :
# DN24073 Martinez, Lester
NPI: 1689235624 LIC: DN24073
CERTIFICATIONS :
# DN17761 Valdman, Vadim
NPI: 1184860413 LIC: DN17761
CERTIFICATIONS :
• Inhalation Sedation
#016880
Allure Dental PLLC
4267 W. Commerical Blvd
Tamarac, FL 33319
(954) 677-3202
Special Needs: Yes
English, Russian, French, Spanish
M-T 9am-5pm
Th-F 9am-5pm
S 9am - 3pm
# DN20596 Coyle, Sean
NPI: 1962814632 LIC: DN20596
CERTIFICATIONS :
# DN20696 Kopynets, Viktor
NPI: 1932517042 LIC: DN20696
CERTIFICATIONS :
• Inhalation Sedation
# DN24073 Martinez, Lester
NPI: 1689235624 LIC: DN24073
CERTIFICATIONS :
# DN17761 Valdman, Vadim
NPI: 1184860413 LIC: DN17761
CERTIFICATIONS :
• Inhalation Sedation
#008282
Andrew Dental Care Center, PA
3909 N. Andrews Ave
Oakland Park, FL 33309
(954) 561-6675
Special Needs: Yes
English, Spanish, Haitian; Haitian
Creole
T 9am - 5pm
W 9am-5pm, Th 8am-5pm,F 9am-5pm
S 9am - 5pm
# DN17611 Riley, Marilyn*
NPI: 1114941614 LIC: DN17611
CERTIFICATIONS :
#016082
Angelic Smiles Dental Spa
9990 Nw 6Th Court
Hollywood, FL 33024
www.angelicsmilesdentalspa.com
(954) 237-3902
Special Needs: No
English, Spanish
M 9am - 6pm,
Th-F 9am-4pm
S 9am - 2pm
# DN19661 Williams, Tosha
NPI: 1609009463 LIC: DN19661
CERTIFICATIONS :
• Inhalation Sedation
#010213
Bella Family Dental, Inc.
19551 Sheridan Street
Pembroke Pines, FL 33332
www.mybellafamilydental,com
(954) 621-7959
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN19939 Ruiz Frontany, Yarimar
NPI: 1134429251 LIC: DN19939
CERTIFICATIONS :
• Inhalation Sedation
#020606
Bright Smiles of Sunrise
10108 W Oakland Park Blvd.
Sunrise, FL 33351
(954) 900-2059
Special Needs: No
English, Spanish
M 10am - 7pm, T 9am - 5pm
W 9am-5pm, Th 9am-6pm,F 9am-5pm
# DN21846 Fonseca, Jacqueline
NPI: 1487005369 LIC: DN21846
CERTIFICATIONS :
#FQHC020446
Broward Community & Family
Health Centers, Inc
162 N. Powerline Rd.
Pompano Beach, FL 33069
www.bcfhc.org
(954) 970-7067
Special Needs: Yes
English, Spanish, Creoles and Pidgins
(other), French
M 8am - 5pm, T 10am - 7pm
W-F 8am-5pm
S 8am - 1pm
# DN23003 Aldorri, Khalid
NPI: 1396261277 LIC: DN23003
CERTIFICATIONS :
# DN24341 Salas, Julio
NPI: 1427619253 LIC: DN24341
CERTIFICATIONS :
# DN22291 Taylor, Shelly
NPI: 1508224155 LIC: DN22291
CERTIFICATIONS :
#012454
Broward Family Dental Care
6260 W. Oakland Park Blvd
Sunrise, FL 33313
(954) 742-7995
Special Needs: Yes
English, Farsi, Spanish
M-T 9am-4pm
W-Th 9am-4pm
S 9am - 7pm
# DN14848 Fadavi, Sayed
NPI: 1245247097 LIC: DN14848
CERTIFICATIONS :
#006578
Broward Mall Dental
8000 W. Broward Blvd, Ste 1123
Plantation, FL 33388
(954) 476-0802
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 5 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#FQHC014907
Community AIDS Resource, Inc.
871 W. Oakland Park Blvd
Fort Lauderdale, FL 33311
(954) 567-7141
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 8am-5pm
Th-F 8am-5pm
# DN13731 Barnes, Curtis
NPI: 1689798936 LIC: DN13731
CERTIFICATIONS :
# DN18139 Casas, Manuel
NPI: 1740420090 LIC: DN18139
CERTIFICATIONS :
# DN20973 Martinez, Amy
NPI: 1124382866 LIC: DN20973
CERTIFICATIONS :
# DN20674 Sardinas, Yoan
NPI: 1992118657 LIC: DN20674
CERTIFICATIONS :
#009929
Coral Springs Family Dentistry
6267 West Sample Road
Coral Springs, FL 33067
www.familydentistryofsouthflorida.c
om
(954) 341-4766
Special Needs: No
English, Spanish, Portuguese
M-T 10am-7pm
W-F 10am-7pm
# DN14972 Stein, Ilya
NPI: 1235260407 LIC: DN14972
CERTIFICATIONS :
#013315
David Eugene, DDS, PLLC
2447 North State Road 7
Fort Lauderdale, FL 33313
(954) 733-9971
Special Needs: Yes
French, English, Creoles and Pidgins
French-based(other)
M-T 9am-5pm
W 9am-5pm, Th 9am-6pm,F 9am-1pm
S 9am - 1pm
# DN18594 Eugene, David
NPI: 1306080304 LIC: DN18594
CERTIFICATIONS :
#019656
Dental Excellence Partners
680 N. University Drive
Pembroke Pines, FL 33024
(954) 982-7645
Special Needs: No
English, Spanish
M-T 8am-6pm
W-F 8am-6pm
# DN20182 Aponte-Barrios, Secil
NPI: 1164714176 LIC: DN20182
CERTIFICATIONS :
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 6 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#020092
Dental Excellence Partners, LLC
4358 N Federal Hwy
Fort Lauderdale, FL 33308
(954) 776-3320
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#015845
Diaz Dental Group
2879 S. University Dr
Davie, FL 33328
(954) 474-2422
Special Needs: Yes
English, Spanish, French
M-T 10am-5pm
W 10am-7pm, Th 10am-5pm
# DN20123 Diaz, Yanet
NPI: 1215376934 LIC: DN20123
CERTIFICATIONS :
#007554
Dr. Ira Goldman
2100 East Hallendale Beach Blvd, Ste
# 409
Hallandale, FL 33009
(954) 456-9844
Special Needs: Yes
English
M 9am - 2pm, T 9am - 5pm
W-Th 9am-5pm
# DN5717 Goldman, Ira*
NPI: 1326113937 LIC: DN5717
CERTIFICATIONS :
#020227
Family Dental Associates PA
6130 West Atlantic Blvd
Margate, FL 33063
(954) 973-0990
Special Needs: Yes
English, Spanish, Creoles and Pidgins
(other)
M-T 8am-5pm
W-Th 8am-5pm
# DN17643 Blackmore, Sofia
NPI: 1427387687 LIC: DN17643
CERTIFICATIONS :
# DN10097 Lewis, Brad
NPI: 1376567685 LIC: DN10097
CERTIFICATIONS :
# DN19201 Mingel, Marc
NPI: 1831402957 LIC: DN19201
CERTIFICATIONS :
# DN13900 Polasky, Steven
NPI: 1366583312 LIC: DN13900
CERTIFICATIONS :
#010038
Family Dental Care
1600 N. State Rd 7, Ste 400
Lauderhill, FL 33313
(954) 581-9228
Special Needs: Yes
English, Spanish, Portuguese
M-T 9am-5pm
W-Th 9am-5pm
S 9am - 1pm
# DN18305 Akel, Bassil
NPI: 1700040557 LIC: DN18305
CERTIFICATIONS :
#008950
Family Smile Dental
701 Promenade Drive Ste 102
Pembroke Pines, FL 33026
(954) 272-9250
Special Needs: Yes
English, Spanish
M 12pm - 7pm, T 9am - 5pm
W-Th 9am-5pm
# DN17384 Mujtaba, Moneeze
NPI: 1609926310 LIC: DN17384
CERTIFICATIONS :
#013821
Gateway Dental Inc
6720 Pines Blvd.
Pembroke Pines, FL 33024
(305) 856-2300
Special Needs: Yes
Spanish, English
M-T 9am-5pm
W-Th 9am-5pm
# DN18302 Herrera, Victoria
NPI: 1114185550 LIC: DN18302
CERTIFICATIONS :
# DN15212 Miranda, Pablo
NPI: 1023036365 LIC: DN15212
CERTIFICATIONS :
# DN15477 Perrotti, Steven
NPI: 1144249780 LIC: DN15477
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
#022831
Gentle Teeth and Braces of
Weston
2751 Executive Park Drive
Fort Lauderdale, FL 33331
(954) 217-0288
Special Needs: Yes
English, Spanish
M-T 8am-8pm
W-Th 8am-8pm
# DN22685 Perez-Borroto Rodrigez,
Daylis
NPI: 1790215309 LIC: DN22685
CERTIFICATIONS :
#017850
Great Smiles Dental of Fort
Lauderdale
2633 E. Commercial Blvd Ste B
Fort Lauderdale, FL 33308
(954) 530-5352
Special Needs: Yes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 7 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 1pm
# DN19482 Murcia, Marcela
NPI: 1588952261 LIC: DN19482
CERTIFICATIONS :
#023228
JM Dental Group Inc
1724 N. University Drive
Pembroke Pines, FL 33024
(954) 432-8000
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN14451 Hernandez, Norberto
NPI: 1285693267 LIC: DN14451
CERTIFICATIONS :
#013365
Lakes Mall Dental Center, PA
11401 Pines Blvd, Ste 220
Pembroke Pines, FL 33026
(954) 432-5515
Special Needs: No
English, Spanish
T 10am - 4pm
W 12pm-7pm, Th 10am-4pm,F
12pm-7pm
S 9am - 3pm
# DN19377 Calderon, Erik
NPI: 1942596416 LIC: DN19377
CERTIFICATIONS :
• Inhalation Sedation
# DN22454 Dominguez, Ivelisse
NPI: 1386098655 LIC: DN22454
CERTIFICATIONS :
#017607
Mercy Dental Group
3172 S. University Dr
Hollywood, FL 33025
(954) 404-6877
Special Needs: Yes
English, Spanish
M 10am - 6pm, T 9am - 5pm
W 9am-5pm, Th 10am-6pm,F
9am-2pm
# DN21842 Alvarado, Yailen
NPI: 1700235363 LIC: DN21842
CERTIFICATIONS :
# DN21847 Diaz, Jany
NPI: 1659729598 LIC: DN21847
CERTIFICATIONS :
#010345
NSU- BGMC Oral & Maxillofacial
Surgery
1600 S. Andrews Ave, 3Rd Floor
Fort Lauderdale, FL 33316
(954) 355-5703
Special Needs: Yes
English, Spanish
M 1pm - 5pm,
W-F 9am-5pm
# DN13419 Ede-Nichols, Diane
NPI: 1225145683 LIC: DN13419
CERTIFICATIONS :
# DN22197 Khatib, Adel
NPI: 1235582503 LIC: DN22197
CERTIFICATIONS :
#010341
NSU- JDCH Center for
Cranio-Facial Pediatric & Dental
Care
3501 Johnson Street, Ste 200
Hollywood, FL 33021
(954) 262-2187
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13419 Ede-Nichols, Diane
NPI: 1225145683 LIC: DN13419
CERTIFICATIONS :
# DN22197 Khatib, Adel
NPI: 1235582503 LIC: DN22197
CERTIFICATIONS :
#018790
Oral 1 Dental Group
7153 N Pine Island Rd
Fort Lauderdale, FL 33321
(954) 532-3247
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN20878 Londono, Laura
NPI: 1679982839 LIC: DN20878
CERTIFICATIONS :
#017867
Pembroke Miro Dental Office
7071 Taft Street
Hollywood, FL 33024
(954) 436-7699
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21293 Merikas, Amanda
NPI: 1669853305 LIC: DN21293
CERTIFICATIONS :
# DN11650 Miro, Claudio
NPI: 1417024118 LIC: DN11650
CERTIFICATIONS :
• Conscious Sedation
#019516
Perfect Smile Dental Spa
117 S. 21St Ave
Hollywood, FL 33020
(954) 364-7626
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W 10am-5pm, Th 12pm-6pm
# DN15823 Galbut, Kimberly
NPI: 1649580747 LIC: DN15823
CERTIFICATIONS :
# DN17884 Lyons, James
NPI: 1851341853 LIC: DN17884
CERTIFICATIONS :
#017093
Preferred Dental Care, PA
2263 S. University Drive
Davie, FL 33324
(954) 475-0700
Special Needs: Yes
English, Russian, Spanish
M 8am - 5pm, T 12pm - 6pm
W-F 8am-5pm
S 9am - 3pm
# DN20596 Coyle, Sean
NPI: 1962814632 LIC: DN20596
CERTIFICATIONS :
# DN20696 Kopynets, Viktor
NPI: 1932517042 LIC: DN20696
CERTIFICATIONS :
• Inhalation Sedation
# DN24073 Martinez, Lester
NPI: 1689235624 LIC: DN24073
CERTIFICATIONS :
# DN19416 Saldana, Ramon
NPI: 1639465735 LIC: DN19416
CERTIFICATIONS :
# DN17761 Valdman, Vadim
NPI: 1184860413 LIC: DN17761
CERTIFICATIONS :
• Inhalation Sedation
#006581
Sawgrass Mills Mall Dental
12801 W. Sunrise Blvd, Ste F222
Sunrise, FL 33323
(954) 846-7171
Special Needs: Yes
Russian, Spanish, Creoles and Pidgins
French-based(other)
M-T 10am-9pm
W-F 10am-9pm
S 10am - 6pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 8 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#016127
Shalom Sunset Dental Care
6491 Sunset Strip, Ste 1
Sunrise, FL 33313
(954) 572-1801
Special Needs: Yes
English, Spanish
M 9am - 6pm,
W-Th 9am-6pm
# DN20938 Castello Polo, Blanca
NPI: 1710380316 LIC: DN20938
CERTIFICATIONS :
#015404
Smile At Margate
5404 W. Atlantic Blvd
Pompano Beach, FL 33063
smileatmargate.com
(954) 974-4400
Special Needs: Yes
English, Farsi, Portuguese, Spanish
M 9am - 5pm, T 9am - 7pm
W 9am-5pm, Th 9am-7pm,F 9am-5pm
S 9am - 3pm
# DN19381 Shayan, Maria
NPI: 1700172673 LIC: DN19381
CERTIFICATIONS :
#010564
Smile Solutions Dental Group
294 Nw 172Nd Ave
Hollywood, FL 33029
(954) 432-3655
Special Needs: No
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 1pm
# DN19465 De Sousa, Marvina
NPI: 1841572963 LIC: DN19465
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
#014644
Smiles Dental PLLC
700 W. Hillsboro Blvd, Ste 1-109,
Bldg 1
Deerfield Beach, FL 33441
(754) 264-7264
Special Needs: No
English, Spanish, Creoles and Pidgins
English-based(other), French, Hindi,
Telugu
M-T 9am-5pm
W-F 9am-5pm
S 9am - 4pm
# DN15925 Atluri, Suneetha
NPI: 1063525731 LIC: DN15925
CERTIFICATIONS :
• Inhalation Sedation
#016630
Soto & Castillo Dental Care Inc
3911 Hollywood Blvd, Ste 102
Hollywood, FL 33021
(954) 987-3344
Special Needs: Yes
English, Spanish, Portuguese
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN20757 Castillo, Sandra
NPI: 1245636133 LIC: DN20757
CERTIFICATIONS :
# DN20370 Soto, Paola
NPI: 1336572007 LIC: DN20370
CERTIFICATIONS :
#015901
Stephen Rothenberg DDS
416 E. Hallandale Beach Blvd.
Hallandale, FL 33009
(954) 457-8288
Special Needs: Yes
Romanian, English, Spanish
M-T 8am-4pm
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 9 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
W-Th 8am-4pm
# DN7410 Rothenberg, Stephen
NPI: 1083802052 LIC: DN7410
CERTIFICATIONS :
#008257
Tin Wai Hui, DMD, PA
17901 Nw 5Th Street, Ste #206
Pembroke Pines, FL 33029
(954) 430-2188
Special Needs: Yes
English, Arabic, Cantonese, Chinese
Mandarin, Russian, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 2pm
# DN15966 Elperin, Alexei
NPI: 1295930063 LIC: DN15966
CERTIFICATIONS :
# DN23439 Fraga, Salome
NPI: 1205322856 LIC: DN23439
CERTIFICATIONS :
# DN12723 Hui, Tin
NPI: 1952408619 LIC: DN12723
CERTIFICATIONS :
# DN15867 Shather, Meriam
NPI: 1790973873 LIC: DN15867
CERTIFICATIONS :
ENDODONTICS
#006578
Broward Mall Dental
8000 W. Broward Blvd, Ste 1123
Plantation, FL 33388
(954) 476-0802
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN13421 Gittess, Robert
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
#010341
NSU- JDCH Center for
Cranio-Facial Pediatric & Dental
Care
3501 Johnson Street, Ste 200
Hollywood, FL 33021
(954) 262-2187
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN9429 Flax, Michael
NPI: 1164583985 LIC: DN9429
CERTIFICATIONS :
# DN18606 Manjarres, Vivian
NPI: 1073747333 LIC: DN18606
CERTIFICATIONS :
# DN17496 Seltzer, Robert
NPI: 1619082120 LIC: DN17496
CERTIFICATIONS :
# DN14230 Zeim, Jason
NPI: 1760498422 LIC: DN14230
CERTIFICATIONS :
#010346
NSU- Pediatric Dental Care
Center @ Kids
819 Ne 26Th St, Ste C
Wilton Manors, FL 33305
(954) 262-1751
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN9429 Flax, Michael
NPI: 1164583985 LIC: DN9429
CERTIFICATIONS :
# DN18606 Manjarres, Vivian
NPI: 1073747333 LIC: DN18606
CERTIFICATIONS :
# DN17496 Seltzer, Robert
NPI: 1619082120 LIC: DN17496
CERTIFICATIONS :
# DN14230 Zeim, Jason
NPI: 1760498422 LIC: DN14230
CERTIFICATIONS :
#006581
Sawgrass Mills Mall Dental
12801 W. Sunrise Blvd, Ste F222
Sunrise, FL 33323
(954) 846-7171
Special Needs: Yes
Russian, Spanish, Creoles and Pidgins
French-based(other)
M-T 10am-9pm
W-F 10am-9pm
S 10am - 6pm
# DN13421 Gittess, Robert
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
ORAL SURGEON
#010345
NSU- BGMC Oral & Maxillofacial
Surgery
1600 S. Andrews Ave, 3Rd Floor
Fort Lauderdale, FL 33316
(954) 355-5703
Special Needs: Yes
English, Spanish
M 1pm - 5pm,
W-F 9am-5pm
# DTP482 McClure, Shawn
NPI: 1649313925 LIC: DTP482
CERTIFICATIONS :
• Board Certification
ORTHODONTIST
#022905
Lighthouse Point Orthodontics
2323 Ne 26Th Ave Ste 107
Pompano Beach, FL 33062
www.lhporthodontics.com
(954) 719-7955
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN20160 Rozen, Daniel
NPI: 1821446352 LIC: DN20160
CERTIFICATIONS :
#010346
NSU- Pediatric Dental Care
Center @ Kids
819 Ne 26Th St, Ste C
Wilton Manors, FL 33305
(954) 262-1751
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DTP600 Contasti-Bocco, Gisela
NPI: 1871903914 LIC: DTP600
CERTIFICATIONS :
# DN16470 Vargas, Jorge
NPI: 1154419349 LIC: DN16470
CERTIFICATIONS :
#022347
Shaun L. Smith DDS PLLC
8223 W. Atlantic Blvd
Pompano Beach, FL 33071
(954) 368-0105
Special Needs: Yes
English, Spanish
M 10am - 6pm, T 9am - 5pm
W 10am-6pm, Th 9am-5pm
# DN23095 Smith, Shaun
NPI: 1932499217 LIC: DN23095
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#010345
NSU- BGMC Oral & Maxillofacial
Surgery
1600 S. Andrews Ave, 3Rd Floor
Fort Lauderdale, FL 33316
(954) 355-5703
Special Needs: Yes
English, Spanish
M 1pm - 5pm,
W-F 9am-5pm
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
# DN17762 Ocanto, Romer
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 10 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1124133426 LIC: DN17762
CERTIFICATIONS :
• Inhalation Sedation
# DN17441 Oramas, Victor
NPI: 1235217571 LIC: DN17441
CERTIFICATIONS :
• Board Certification
#010341
NSU- JDCH Center for
Cranio-Facial Pediatric & Dental
Care
3501 Johnson Street, Ste 200
Hollywood, FL 33021
(954) 262-2187
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN4823 Arnold Jr., Dan
NPI: 1275644668 LIC: DN4823
CERTIFICATIONS :
• Inhalation Sedation
# DTP695 Cabassa Latoni, Roberto
NPI: 1063483444 LIC: DTP695
CERTIFICATIONS :
# DTP643 Chin, Judith
NPI: 1124151592 LIC: DTP643
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DTP648 Kim, Margaret
NPI: 1649292103 LIC: DTP648
CERTIFICATIONS :
• Inhalation Sedation
# DTP259 Larumbe, Jose
NPI: 1972605038 LIC: DTP259
CERTIFICATIONS :
• Inhalation Sedation
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
# DN17762 Ocanto, Romer
NPI: 1124133426 LIC: DN17762
CERTIFICATIONS :
• Inhalation Sedation
# DN17441 Oramas, Victor
NPI: 1235217571 LIC: DN17441
CERTIFICATIONS :
• Board Certification
# DTP557 Padilla, Oscar
NPI: 1669478863 LIC: DTP557
CERTIFICATIONS :
• Inhalation Sedation
#010342
NSU- Mailman Segal Institute -
Dental
7600 Sw 36Th Street, Bldg.100,
Room 1263
Davie, FL 33328
(954) 262-7127
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17762 Ocanto, Romer
NPI: 1124133426 LIC: DN17762
CERTIFICATIONS :
• Inhalation Sedation
#010346
NSU- Pediatric Dental Care
Center @ Kids
819 Ne 26Th St, Ste C
Wilton Manors, FL 33305
(954) 262-1751
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN4823 Arnold Jr., Dan
NPI: 1275644668 LIC: DN4823
CERTIFICATIONS :
• Inhalation Sedation
# DTP695 Cabassa Latoni, Roberto
NPI: 1063483444 LIC: DTP695
CERTIFICATIONS :
# DTP643 Chin, Judith
NPI: 1124151592 LIC: DTP643
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DTP648 Kim, Margaret
NPI: 1649292103 LIC: DTP648
CERTIFICATIONS :
• Inhalation Sedation
# DTP259 Larumbe, Jose
NPI: 1972605038 LIC: DTP259
CERTIFICATIONS :
• Inhalation Sedation
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
# DN17762 Ocanto, Romer
NPI: 1124133426 LIC: DN17762
CERTIFICATIONS :
• Inhalation Sedation
# DN17441 Oramas, Victor
NPI: 1235217571 LIC: DN17441
CERTIFICATIONS :
• Board Certification
# DTP557 Padilla, Oscar
NPI: 1669478863 LIC: DTP557
CERTIFICATIONS :
• Inhalation Sedation
PERIODONTICS
#006578
Broward Mall Dental
8000 W. Broward Blvd, Ste 1123
Plantation, FL 33388
(954) 476-0802
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
#006581
Sawgrass Mills Mall Dental
12801 W. Sunrise Blvd, Ste F222
Sunrise, FL 33323
(954) 846-7171
Special Needs: Yes
Russian, Spanish, Creoles and Pidgins
French-based(other)
M-T 10am-9pm
W-F 10am-9pm
S 10am - 6pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
CALHOUN COUNTY
DENTIST
#016515
Layne & Barth Family Dentistry,
P.A.
19606 State Road 20 W
Blountstown, FL 32424
www.laynefamilydentistry.com
(850) 674-5502
Special Needs: Yes
English
M-T 8am-5pm
W-Th 8am-5pm
# DN19827 Barth, Nicholas*
NPI: 1396090320 LIC: DN19827
CERTIFICATIONS :
• Inhalation Sedation
# DN18715 Layne, Brad*
NPI: 1851528962 LIC: DN18715
CERTIFICATIONS :
#013160
Myron D. Schrock, DMD, PA
17470 North Main Street
Blountstown, FL 32424
www.myronshrockdmd.com
(850) 237-1400
Special Needs: Yes
English
M-T 8am-5pm
W 8am-5pm,
# DN13527 Schrock, Myron
NPI: 1730245846 LIC: DN13527
CERTIFICATIONS :
CHARLOTTE COUNTY
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 11 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
DENTIST
#CHC011905
DOH - Charlotte County Health
Department
1100 Loveland Blvd
Port Charlotte, FL 33980
(941) 624-7200
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# HAD79 Cocchieri, Richard
NPI: 1578685491 LIC: HAD79
CERTIFICATIONS :
# HAD100 Miles, Kenneth
NPI: 1063563724 LIC: HAD100
CERTIFICATIONS :
CITRUS COUNTY
DENTIST
#CHC011210M
DOH - Citrus County Health
Department (Mobile Unit)
3700 W. Sovereign Path
Lecanto, FL 34461
(352) 527-5737
Special Needs: Yes
English
# DN11385 Traul Jr., Robert*
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
#FQHC016660
Langley Health Services
314 S. Line Ave
Inverness, FL 34452
(352) 419-4056
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN23356 Lutes, Meaghan
NPI: 1760974554 LIC: DN23356
CERTIFICATIONS :
# DN21931 Reddy, Rekha
NPI: 1588017990 LIC: DN21931
CERTIFICATIONS :
# DN17030 Sykes, Daniel
NPI: 1528273703 LIC: DN17030
CERTIFICATIONS :
# DN13460 Tutay, John
NPI: 1043413180 LIC: DN13460
CERTIFICATIONS :
CLAY COUNTY
DENTIST
#CHC9679
DOH - Clay County Health
Department- Mobile Dental Unit
1305 Idlewild Ave
Green Cove Springs, FL 32043
(904) 259-6291
Special Needs: Yes
English
M-T 8am-5pm
W-Th 8am-5pm
# DN14307 Gupton, Frank*
NPI: 1962411876 LIC: DN14307
CERTIFICATIONS :
• Inhalation Sedation
# DN11888 Hackney, Tara*
NPI: 1710953765 LIC: DN11888
CERTIFICATIONS :
• Inhalation Sedation
# DN10644 Steen, Phillip*
NPI: 1215078506 LIC: DN10644
CERTIFICATIONS :
• Inhalation Sedation
# DN16471 Varghese, George*
NPI: 1598955205 LIC: DN16471
CERTIFICATIONS :
#008723
Walnut Street Dental Center
407 Walnut Street
Green Cove Springs, FL 32043
(904) 284-0773
Special Needs: N/A
Sign Languages
M-T 9am-5pm
Th-F 9am-5pm
# DN7301 McCabe, John*
NPI: 1588734149 LIC: DN7301
CERTIFICATIONS :
ORAL SURGEON
#018291
Imray & Gesek DMD PA
1409 Kingsley Ave Ste 5
Orange Park, FL 32073
(904) 264-7383
Special Needs: Yes
English
M 8am - 5pm,
F 7am-2pm
# DN13575 Gesek, Daniel
NPI: 1831129774 LIC: DN13575
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN10533 Imray, Scott
NPI: 1740362367 LIC: DN10533
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
COLLIER COUNTY
DENTIST
#CHC015257
DOH - Collier County Health
Department
3339 East Tamiami Trail, Ste 145
Naples, FL 34106
(239) 252-5314
Special Needs: Yes
English, Spanish, Italian, Romanian
M-T 7am-4pm
W 7am-5pm, Th 7am-4pm,F 7am-5pm
# DN19780 Danu, Dana
NPI: 1174887327 LIC: DN19780
CERTIFICATIONS :
# DN15182 Johnson, Kelley
NPI: 1699853887 LIC: DN15182
CERTIFICATIONS :
#FQHC013671
Healthcare Network of SW FL
1454 Madison Ave
Immokalee, FL 34142
(239) 658-3000
Special Needs: No
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD90 Ellsworth, Kathleen*
NPI: 1174526651 LIC: HAD90
CERTIFICATIONS :
# DN14099 Ferrer, Norma*
NPI: 1518139989 LIC: DN14099
CERTIFICATIONS :
• Inhalation Sedation
# DN19676 Gross, Eitan*
NPI: 1326474768 LIC: DN19676
CERTIFICATIONS :
• General Anesthesia
# DN20893 Larios, Filadelfo*
NPI: 1932508355 LIC: DN20893
CERTIFICATIONS :
• Inhalation Sedation
# DN18068 Le, Jade*
NPI: 1154541845 LIC: DN18068
CERTIFICATIONS :
• Conscious Sedation
• Inhalation Sedation
# DN21878 Mancera-Loftin, Julie*
NPI: 1033569447 LIC: DN21878
CERTIFICATIONS :
• Inhalation Sedation
# DN22155 Ochoa, Margarita*
NPI: 1376785329 LIC: DN22155
CERTIFICATIONS :
• Inhalation Sedation
# DN19289 Orr, Elizabeth*
NPI: 1346234853 LIC: DN19289
CERTIFICATIONS :
• Inhalation Sedation
# DN23447 Patalinghug, Lady
Joedeline*
NPI: 1700232535 LIC: DN23447
CERTIFICATIONS :
# DN23771 Riggio, Anthony*
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 12 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1043716996 LIC: DN23771
CERTIFICATIONS :
#FQHC013672
Healthcare Network of SW FL
1749 Heritage Trail Ste # 801
Naples, FL 34112
(239) 658-3000
Special Needs: No
English Old (ca.450-1100), Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD90 Ellsworth, Kathleen
NPI: 1174526651 LIC: HAD90
CERTIFICATIONS :
# DN14099 Ferrer, Norma
NPI: 1518139989 LIC: DN14099
CERTIFICATIONS :
• Inhalation Sedation
# DN20893 Larios, Filadelfo
NPI: 1932508355 LIC: DN20893
CERTIFICATIONS :
• Inhalation Sedation
# DN18068 Le, Jade
NPI: 1154541845 LIC: DN18068
CERTIFICATIONS :
• Conscious Sedation
• Inhalation Sedation
# DN21878 Mancera-Loftin, Julie
NPI: 1033569447 LIC: DN21878
CERTIFICATIONS :
• Inhalation Sedation
# DN22155 Ochoa, Margarita
NPI: 1376785329 LIC: DN22155
CERTIFICATIONS :
• Inhalation Sedation
# DN19289 Orr, Elizabeth
NPI: 1346234853 LIC: DN19289
CERTIFICATIONS :
• Inhalation Sedation
# DN23447 Patalinghug, Lady
Joedeline
NPI: 1700232535 LIC: DN23447
CERTIFICATIONS :
# DN23771 Riggio, Anthony
NPI: 1043716996 LIC: DN23771
CERTIFICATIONS :
#FQHC014580
Healthcare Network of SW FL
4077 Tamiami Trail N
Naples, FL 34103
(239) 658-3000
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD90 Ellsworth, Kathleen
NPI: 1174526651 LIC: HAD90
CERTIFICATIONS :
# DN19676 Gross, Eitan
NPI: 1326474768 LIC: DN19676
CERTIFICATIONS :
• General Anesthesia
# DN20893 Larios, Filadelfo
NPI: 1932508355 LIC: DN20893
CERTIFICATIONS :
• Inhalation Sedation
# DN18068 Le, Jade
NPI: 1154541845 LIC: DN18068
CERTIFICATIONS :
• Conscious Sedation
• Inhalation Sedation
# DN21878 Mancera-Loftin, Julie
NPI: 1033569447 LIC: DN21878
CERTIFICATIONS :
• Inhalation Sedation
# DN22155 Ochoa, Margarita
NPI: 1376785329 LIC: DN22155
CERTIFICATIONS :
• Inhalation Sedation
# DN19289 Orr, Elizabeth
NPI: 1346234853 LIC: DN19289
CERTIFICATIONS :
• Inhalation Sedation
# DN23447 Patalinghug, Lady
Joedeline
NPI: 1700232535 LIC: DN23447
CERTIFICATIONS :
# DN23771 Riggio, Anthony
NPI: 1043716996 LIC: DN23771
CERTIFICATIONS :
#FQHC022371
Healthcare Network of SW FL
2355 Stanford Ct, Ste 701
Naples, FL 34112
(239) 658-3000
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 8am-5pm
W-F 8am-5pm
# HAD90 Ellsworth, Kathleen
NPI: 1174526651 LIC: HAD90
CERTIFICATIONS :
# DN19676 Gross, Eitan
NPI: 1326474768 LIC: DN19676
CERTIFICATIONS :
• General Anesthesia
# DN20893 Larios, Filadelfo
NPI: 1932508355 LIC: DN20893
CERTIFICATIONS :
• Inhalation Sedation
# DN18068 Le, Jade
NPI: 1154541845 LIC: DN18068
CERTIFICATIONS :
• Conscious Sedation
• Inhalation Sedation
# DN21878 Mancera-Loftin, Julie
NPI: 1033569447 LIC: DN21878
CERTIFICATIONS :
• Inhalation Sedation
# DN22155 Ochoa, Margarita
NPI: 1376785329 LIC: DN22155
CERTIFICATIONS :
• Inhalation Sedation
# DN19289 Orr, Elizabeth
NPI: 1346234853 LIC: DN19289
CERTIFICATIONS :
• Inhalation Sedation
# DN23447 Patalinghug, Lady
Joedeline
NPI: 1700232535 LIC: DN23447
CERTIFICATIONS :
#014619
Northern Dental General and
Cosmetic Dentistry LLC
5651 Naples Blvd
Naples, FL 34109
(239) 431-5666
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN20711 Novak, Shannon
NPI: 1871904581 LIC: DN20711
CERTIFICATIONS :
#017214
Polo Dental of Naples
4280 Tamiami Trail East, Ste 201
Naples, FL 34112
(239) 258-0421
Special Needs: Yes
English, Spanish, French
M 10am - 6pm, T 9am - 6pm
W 9am-7pm, Th 9am-6pm
# DN23676 Aldaya, Robair
NPI: 1508344599 LIC: DN23676
CERTIFICATIONS :
# DN23633 Andrade, Emily
NPI: 1407335409 LIC: DN23633
CERTIFICATIONS :
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
CERTIFICATIONS :
# DN17996 Etemadshahidi, Babak
NPI: 1336300805 LIC: DN17996
CERTIFICATIONS :
# DN24425 Faizzadeh, Paula
NPI: 1912550799 LIC: DN24425
CERTIFICATIONS :
# DN23511 Nguyen, Chi
NPI: 1811482656 LIC: DN23511
CERTIFICATIONS :
• Inhalation Sedation
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 13 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN22552 Ramirez Gonzalez,
Carmen
NPI: 1134659543 LIC: DN22552
CERTIFICATIONS :
# DN24429 Shahriari, Varahram
NPI: 1952954778 LIC: DN24429
CERTIFICATIONS :
# DN16481 Zadov, Marianna
NPI: 1104903301 LIC: DN16481
CERTIFICATIONS :
• Inhalation Sedation
#022815
Wisdom Dental PA
5064 Annunciation Circle, Ste 101
Ave Maria, FL 34142
(239) 919-6930
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21551 Akpaka, Wisdom
NPI: 1114338738 LIC: DN21551
CERTIFICATIONS :
ENDODONTICS
#FQHC013671
Healthcare Network of SW FL
1454 Madison Ave
Immokalee, FL 34142
(239) 658-3000
Special Needs: No
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23310 Patalinghug, Ulysses*
NPI: 1689020935 LIC: DN23310
CERTIFICATIONS :
#FQHC013672
Healthcare Network of SW FL
1749 Heritage Trail Ste # 801
Naples, FL 34112
(239) 658-3000
Special Needs: No
English Old (ca.450-1100), Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23310 Patalinghug, Ulysses
NPI: 1689020935 LIC: DN23310
CERTIFICATIONS :
#FQHC014580
Healthcare Network of SW FL
4077 Tamiami Trail N
Naples, FL 34103
(239) 658-3000
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23310 Patalinghug, Ulysses
NPI: 1689020935 LIC: DN23310
CERTIFICATIONS :
#FQHC022371
Healthcare Network of SW FL
2355 Stanford Ct, Ste 701
Naples, FL 34112
(239) 658-3000
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN23310 Patalinghug, Ulysses
NPI: 1689020935 LIC: DN23310
CERTIFICATIONS :
ORTHODONTIST
#017214
Polo Dental of Naples
4280 Tamiami Trail East, Ste 201
Naples, FL 34112
(239) 258-0421
Special Needs: Yes
English, Spanish, French
M 10am - 6pm, T 9am - 6pm
W 9am-7pm, Th 9am-6pm
# DN19915 Naghavi, Nona
NPI: 1649318262 LIC: DN19915
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#FQHC013671
Healthcare Network of SW FL
1454 Madison Ave
Immokalee, FL 34142
(239) 658-3000
Special Needs: No
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17804 Gedeon, Rose*
NPI: 1063547545 LIC: DN17804
CERTIFICATIONS :
• Inhalation Sedation
#FQHC014580
Healthcare Network of SW FL
4077 Tamiami Trail N
Naples, FL 34103
(239) 658-3000
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17804 Gedeon, Rose
NPI: 1063547545 LIC: DN17804
CERTIFICATIONS :
• Inhalation Sedation
PERIODONTICS
#017214
Polo Dental of Naples
4280 Tamiami Trail East, Ste 201
Naples, FL 34112
(239) 258-0421
Special Needs: Yes
English, Spanish, French
M 10am - 6pm, T 9am - 6pm
W 9am-7pm, Th 9am-6pm
# DN23115 Mendoza, Juan
NPI: 1821326430 LIC: DN23115
CERTIFICATIONS :
• Inhalation Sedation
# DN11699 Simon, David
NPI: 1508303587 LIC: DN11699
CERTIFICATIONS :
• Oral / Enteral Sedation
COLUMBIA COUNTY
DENTIST
#FQHC012459
Palms Dentistry
173 Nw Albritton Lane
Lake City, FL 32055
(386) 752-5904
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN9869 Jones, Stanley
NPI: 1528162047 LIC: DN9869
CERTIFICATIONS :
# DN24208 Lima, Pamela
NPI: 1982264438 LIC: DN24208
CERTIFICATIONS :
# DN20927 Rooney, Matthew
NPI: 1598165532 LIC: DN20927
CERTIFICATIONS :
• Inhalation Sedation
DE SOTO COUNTY
DENTIST
#CHC10198
DOH - DeSoto County Health
Department
34 S. Baldwin Ave
Arcadia, FL 34266
(863) 993-4601
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD53 Morris, Thomas
NPI: 1548396385 LIC: HAD53
CERTIFICATIONS :
# DN14917 Perez, Tomas
NPI: 1861613846 LIC: DN14917
CERTIFICATIONS :
# DN18285 Snyder, Kirk
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 14 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1295996767 LIC: DN18285
CERTIFICATIONS :
DIXIE COUNTY
DENTIST
#011247
Family Cosmetic Dentistry
91 Se Highway 349
Old Town, FL 32680
(352) 542-7400
Special Needs: No
English
# DN9531 Attia, Safwat*
NPI: 1952311730 LIC: DN9531
CERTIFICATIONS :
DUVAL COUNTY
DENTIST
#009170
1 Day Denture
1329 Lane Ave South, Ste 1
Jacksonville, FL 32205
www.1daydenturejax.com
(904) 683-0415
Special Needs: Yes
English, Spanish
T 8am - 4pm
W-F 8am-4pm
# DN17326 Bunch, Nicole
NPI: 1891824934 LIC: DN17326
CERTIFICATIONS :
# DN3300 Chamberlain, Norman
NPI: 1912155631 LIC: DN3300
CERTIFICATIONS :
• Inhalation Sedation
# DN21448 Rageer, Padma
NPI: 1285018333 LIC: DN21448
CERTIFICATIONS :
#008933
A Better Smile Denture Center
7645 Merrill Road Ste 305
Jacksonville, FL 32277
(904) 493-1005
Special Needs: Yes
English, Spanish, Gujarati, Hindi
M-T 8am-4pm
W-Th 8am-4pm
# DN8397 Morrison, Wendell
NPI: 1114104775 LIC: DN8397
CERTIFICATIONS :
# DN15848 Mumford-Clarke,
Kymberli
NPI: 1316965742 LIC: DN15848
CERTIFICATIONS :
• Inhalation Sedation
#FQHC020800
Beaches Community Health
Dental Clinic
850 6Th Ave South Ste #500
Jacksonville Beach, FL 32250
(904) 394-5471
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN20641 Makary, Sara
NPI: 1851704654 LIC: DN20641
CERTIFICATIONS :
# DN20613 Martin, Shakela
NPI: 1639582943 LIC: DN20613
CERTIFICATIONS :
#018601
CAN Community Health, Inc.
4615 Philips Hwy Ste 200
Jacksonville, FL 32207
(904) 508-0710
Special Needs: No
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN14864 Henry, Stephen*
NPI: 1851455117 LIC: DN14864
CERTIFICATIONS :
#019497
DDS Dental Center
305 E Union St
Jacksonville, FL 32202
(904) 717-9161
Special Needs: No
English, Spanish, Tamil
T 9am - 5pm
W-F 9am-5pm
# DN17040 Cepeda, Rafael*
NPI: 1205084472 LIC: DN17040
CERTIFICATIONS :
#010665
Dental Place of Jax, P.A.
5800 Beach Blvd, Ste 102
Jacksonville, FL 32207
(904) 330-0630
Special Needs: Yes
English, Spanish
M-T 8am-4pm
# DN17326 Bunch, Nicole
NPI: 1891824934 LIC: DN17326
CERTIFICATIONS :
#021571
Dentures & More - Coastal Dental
Services
4402 Old Sailsbury Road
Jacksonville, FL 32216
(904) 296-7757
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN6329 Davis, Robert
NPI: 1962613901 LIC: DN6329
CERTIFICATIONS :
#FQHC020799
I.M. Sulzbacher Center for the
Homeless, Inc.
611 E. Adams Street
Jacksonville, FL 32202
(904) 394-8060
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN20641 Makary, Sara*
NPI: 1851704654 LIC: DN20641
CERTIFICATIONS :
# DN20613 Martin, Shakela*
NPI: 1639582943 LIC: DN20613
CERTIFICATIONS :
#009752
Regency Square Mall Dental P.A.
9501 Arlington Express Way Ste
0345
Jacksonville, FL 32225
(904) 727-6055
Special Needs: Yes
Russian, Arabic, English, Spanish
M-T 10am-7pm
W-F 10am-7pm
S 10am - 7pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 15 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#016481
Rick K. Harrison DMD PA
227 11Th Ave South
Jacksonville Beach, FL 32250
(904) 241-4237
Special Needs: Yes
English
M-T 8am-6pm
Th-F 8am-2pm
# DN11991 Harrison, Rick*
NPI: 1548263445 LIC: DN11991
CERTIFICATIONS :
• Inhalation Sedation
ENDODONTICS
#009752
Regency Square Mall Dental P.A.
9501 Arlington Express Way Ste
0345
Jacksonville, FL 32225
(904) 727-6055
Special Needs: Yes
Russian, Arabic, English, Spanish
M-T 10am-7pm
W-F 10am-7pm
S 10am - 7pm
# DN13421 Gittess, Robert*
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
ORAL SURGEON
#018290
Imray & Gesek DMD PA
2047 Park St
Jacksonville, FL 32204
(904) 264-7383
Special Needs: Yes
English
M-T 8am-5pm
W-Th 8am-5pm
# DN13575 Gesek, Daniel
NPI: 1831129774 LIC: DN13575
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN10533 Imray, Scott
NPI: 1740362367 LIC: DN10533
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
#009752
Regency Square Mall Dental P.A.
9501 Arlington Express Way Ste
0345
Jacksonville, FL 32225
(904) 727-6055
Special Needs: Yes
Russian, Arabic, English, Spanish
M-T 10am-7pm
W-F 10am-7pm
S 10am - 7pm
# DN19286 Rand, Matthew*
NPI: 1740407030 LIC: DN19286
CERTIFICATIONS :
• General Anesthesia
PERIODONTICS
# DN13591 Nielsen, Pamela*
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
ESCAMBIA COUNTY
DENTIST
#FQHC013509
Community Health Northwest
Florida
1295 W. Fairfield Dr
Pensacola, FL 32501
(850) 912-8880
Special Needs: Yes
English
M-T 7am-4pm
W-F 7am-4pm
# DN8846 Copenhaver, Lawrence
NPI: 1366409807 LIC: DN8846
CERTIFICATIONS :
# DN23413 Digby, Gregory
NPI: 1437646080 LIC: DN23413
CERTIFICATIONS :
# DN19082 Hernandez, Gabriel
NPI: 1093956088 LIC: DN19082
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#FQHC014964
Community Health Northwest
Florida
470 S. Hwy 29 Ste B
Cantonment, FL 32533
(850) 780-0111
Special Needs: Yes
English, Spanish
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 16 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
M-T 7am-4pm
W-F 7am-4pm
# DN8846 Copenhaver, Lawrence
NPI: 1366409807 LIC: DN8846
CERTIFICATIONS :
# DN23413 Digby, Gregory
NPI: 1437646080 LIC: DN23413
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#FQHC014990
Community Health Northwest
Florida
501 Church Street
Century, FL 32535
healthcarewithinreach.org
(850) 724-4054
Special Needs: Yes
English, Spanish
T 8am - 4pm
# DN8846 Copenhaver, Lawrence
NPI: 1366409807 LIC: DN8846
CERTIFICATIONS :
# DN23413 Digby, Gregory
NPI: 1437646080 LIC: DN23413
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#FQHC022628
Community Health Northwest
Florida
6021 Industrial Blvd
Century, FL 32535
(850) 724-4064
Special Needs: Yes
English
M-T 8am-4pm
W-F 8am-4pm
# DN8846 Copenhaver, Lawrence
NPI: 1366409807 LIC: DN8846
CERTIFICATIONS :
# DN23413 Digby, Gregory
NPI: 1437646080 LIC: DN23413
CERTIFICATIONS :
# DN19082 Hernandez, Gabriel
NPI: 1093956088 LIC: DN19082
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#013222
Cordova Dental Center
5120 Bayou Blvd, Ste #4
Pensacola, FL 32503
(850) 477-3188
Special Needs: Yes
English, Farsi, Vietnamese
M-T 9am-5pm
W-F 9am-5pm
# DN11910 Schildroth, Charles
NPI: 1740334655 LIC: DN11910
CERTIFICATIONS :
FLAGLER COUNTY
DENTIST
#CHC10022
DOH - Flagler County Health
Department
301 Dr Carter Bvd
Bunnell, FL 32110
(386) 437-7350
Special Needs: Yes
English, Russian, Creoles and Pidgins
English-based(other), Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN16666 Bey, Frances
NPI: 1760458798 LIC: DN16666
CERTIFICATIONS :
# DN12581 Ramirez, Benigno
NPI: 1043230295 LIC: DN12581
CERTIFICATIONS :
#010967
Mark L Johnson, DDS, PA
215 South Third Street
Flagler Beach, FL 32136
(386) 439-9688
Special Needs: Yes
English
M-T 8am-4pm
W-Th 8am-4pm
# DN15035 Johnson, Mark
NPI: 1154443513 LIC: DN15035
CERTIFICATIONS :
FRANKLIN COUNTY
DENTIST
#FQHC015406
PanCare of Florida
106 Ne 5Th St
Carrabelle, FL 32322
(850) 215-3578
Special Needs: No
English
M-T 8am-5pm
W-F 8am-5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# DN23419 Lindsay, Sean
NPI: 1477046290 LIC: DN23419
CERTIFICATIONS :
# DN21740 Moffa, Michelle
NPI: 1841277407 LIC: DN21740
CERTIFICATIONS :
# DN19745 Norton, Andrew
NPI: 1861754020 LIC: DN19745
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
ENDODONTICS
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
GADSDEN COUNTY
DENTIST
#FQHC015507
Jessie Furlow Medical Center
1249 Strong Rd
Quincy, FL 32351
www.northfloridamedicalcenters.org
(850) 875-9502
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN11230 Cherkinsky, Jordan
NPI: 1184637787 LIC: DN11230
CERTIFICATIONS :
# DN24185 Durham, Dominique
NPI: 1053972257 LIC: DN24185
CERTIFICATIONS :
#FQHC011429
Neighborhood Medical Center
604 E. 5Th Ave
Havana, FL 32333
(850) 539-8222
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 8am-6pm
W-F 8am-6pm
# DN15616 Abreu, Romelio
NPI: 1568639268 LIC: DN15616
CERTIFICATIONS :
# DN22475 Butler, Latoya
NPI: 1003357351 LIC: DN22475
CERTIFICATIONS :
# HAD84 Hall, Shai
NPI: 1013043637 LIC: HAD84
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 17 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN20236 Laing, Christopher
NPI: 1356696272 LIC: DN20236
CERTIFICATIONS :
# DN18939 Thiry, Warren
NPI: 1477871697 LIC: DN18939
CERTIFICATIONS :
# DN20886 Wells, Rachelle
NPI: 1588858286 LIC: DN20886
CERTIFICATIONS :
• Inhalation Sedation
ENDODONTICS
#014905
Dental Workz of Quincy
314 E. Jefferson St
Quincy, FL 32351
(850) 618-0114
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W 12pm-6pm, Th 9am-6pm,F
9am-2pm
S 9am - 2pm
# DN21408 Howard, Enrique
NPI: 1639540446 LIC: DN21408
CERTIFICATIONS :
GLADES COUNTY
DENTIST
#FQHC011249
Florida Community Health
Centers, Inc.
1021 Health Park Drive
Moore Haven, FL 33471
(863) 946-0405
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other), French
M-T 8am-5pm
W 8am-6pm, Th 8am-5pm,F 8am-4pm
# DN20720 Blackwood, Alberto
NPI: 1487057303 LIC: DN20720
CERTIFICATIONS :
# DN13607 Morales, Carlos
NPI: 1457310559 LIC: DN13607
CERTIFICATIONS :
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN23400 Pham, Emily
NPI: 1851947568 LIC: DN23400
CERTIFICATIONS :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
# DN13207 Zayas, Alida
NPI: 1639148968 LIC: DN13207
CERTIFICATIONS :
GULF COUNTY
DENTIST
#FQHC014254
PanCare of Florida
2475 Garrison Ave
Port Saint Joe, FL 32456
(850) 215-3578
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# DN23419 Lindsay, Sean
NPI: 1477046290 LIC: DN23419
CERTIFICATIONS :
# DN21740 Moffa, Michelle
NPI: 1841277407 LIC: DN21740
CERTIFICATIONS :
# DN19745 Norton, Andrew
NPI: 1861754020 LIC: DN19745
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
#FQHC014285
PanCare of Florida
807 W. Hwy 22
Wewahitchka, FL 32465
PANCAREFL.ORG
(850) 215-3578
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# DN22620 Knowles, Laura
NPI: 1346778412 LIC: DN22620
CERTIFICATIONS :
# DN23419 Lindsay, Sean
NPI: 1477046290 LIC: DN23419
CERTIFICATIONS :
# DN21740 Moffa, Michelle
NPI: 1841277407 LIC: DN21740
CERTIFICATIONS :
# DN19745 Norton, Andrew
NPI: 1861754020 LIC: DN19745
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
ENDODONTICS
#FQHC014254
PanCare of Florida
2475 Garrison Ave
Port Saint Joe, FL 32456
(850) 215-3578
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
#FQHC014285
PanCare of Florida
807 W. Hwy 22
Wewahitchka, FL 32465
PANCAREFL.ORG
(850) 215-3578
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
HARDEE COUNTY
DENTIST
#FQHC010736
Central Florida Health Care Inc
121 Kd Revell Rd
Wauchula, FL 33873
(863) 767-0696
Special Needs: Yes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 18 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 7am-5pm
W-F 7am-5pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
HENDRY COUNTY
DENTIST
#CHC014622
DOH - Hendry County (School
Based)
1140 Pratt Blvd
Labelle, FL 33935
(863) 674-4041
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD100 Miles, Kenneth*
NPI: 1063563724 LIC: HAD100
CERTIFICATIONS :
# DN11385 Traul Jr., Robert*
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
#FQHC011248
Florida Community Health
Centers, Inc.
315 S. W C Owen Ave
Clewiston, FL 33440
(863) 983-7813
Special Needs: Yes
English, Spanish
M 8am - 5pm, T 8am - 6pm
W-Th 8am-5pm
# DN20720 Blackwood, Alberto
NPI: 1487057303 LIC: DN20720
CERTIFICATIONS :
# DN13607 Morales, Carlos
NPI: 1457310559 LIC: DN13607
CERTIFICATIONS :
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN23400 Pham, Emily
NPI: 1851947568 LIC: DN23400
CERTIFICATIONS :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
# DN13207 Zayas, Alida
NPI: 1639148968 LIC: DN13207
CERTIFICATIONS :
#014861
Ileana Moya, Inc
872 W. Sugarland Hwy
Clewiston, FL 33440
(863) 983-5600
Special Needs: Yes
English, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN20337 Moya, Ileana
NPI: 1710319140 LIC: DN20337
CERTIFICATIONS :
HERNANDO COUNTY
DENTIST
#FQHC016313
Premier Community HealthCare
Group, Inc.
300 S. Main St
Brooksville, FL 34601
(352) 518-2000
Special Needs: Yes
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# DN11556 Baker, Wayne
NPI: 1699833947 LIC: DN11556
CERTIFICATIONS :
# DN14806 Barinas-Duval, Froilan
NPI: 1699748442 LIC: DN14806
CERTIFICATIONS :
• Inhalation Sedation
# DN19998 Nazco-Batista, Maria
NPI: 1093050676 LIC: DN19998
CERTIFICATIONS :
• Inhalation Sedation
# DN20707 Painter, Lisa
NPI: 1083031926 LIC: DN20707
CERTIFICATIONS :
# DN13891 Peralta, Jose
NPI: 1962462036 LIC: DN13891
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
#FQHC016314
Premier Community HealthCare
Group, Inc.
7551 Forest Oaks Blvd
Spring Hill, FL 34606
(352) 518-2000
Special Needs: Yes
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# DN11556 Baker, Wayne
NPI: 1699833947 LIC: DN11556
CERTIFICATIONS :
# DN14806 Barinas-Duval, Froilan
NPI: 1699748442 LIC: DN14806
CERTIFICATIONS :
• Inhalation Sedation
# DN19998 Nazco-Batista, Maria
NPI: 1093050676 LIC: DN19998
CERTIFICATIONS :
• Inhalation Sedation
# DN20707 Painter, Lisa
NPI: 1083031926 LIC: DN20707
CERTIFICATIONS :
# DN13891 Peralta, Jose
NPI: 1962462036 LIC: DN13891
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
HIGHLANDS COUNTY
DENTIST
#CHC7920
Central Florida Health Care
950 County Road 17-A West
Avon Park, FL 33825
(863) 452-3050
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 19 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Special Needs: Yes
Spanish, English, Creoles and Pidgins
English-based(other), French
M-T 7am-5pm
W-F 7am-5pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN24008 Pettit, Karen
NPI: 1285123414 LIC: DN24008
CERTIFICATIONS :
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#CHC10103
DOH - Highlands
106 N. Main Ave
Lake Placid, FL 33852
(863) 382-7257
Special Needs: Yes
Spanish, English
M 8am - 5pm,
# DN17405 Ward, Tasha*
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#CHC10101
DOH - Highlands County Health
Department
7205 S. George Blvd
Sebring, FL 33875
(863) 382-7257
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN14917 Perez, Tomas*
NPI: 1861613846 LIC: DN14917
CERTIFICATIONS :
# DN18285 Snyder, Kirk*
NPI: 1295996767 LIC: DN18285
CERTIFICATIONS :
# DN11385 Traul Jr., Robert*
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
HILLSBOROUGH COUNTY
DENTIST
#011547
Brandon Mall Dental PA
675 Brandon Town Center Mall
Brandon, FL 33511
(813) 681-8600
Special Needs: Yes
English, Russian, Spanish
T 10am - 4pm
W 10am-5pm, Th 10am-6pm,F
11am-6pm
S 9am - 5pm, Su 10am - 5pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 20 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#013955
Broadway Dental
5811 E. Broadway Ave
Tampa, FL 33619
www.tampabroadwaydental.com
(813) 623-1014
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN20256 Doshi, Amit
NPI: 1376983338 LIC: DN20256
CERTIFICATIONS :
#018497
Cordica Dental Designs
104 E Fletcher Ave
Tampa, FL 33612
(813) 661-1800
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN15530 Perez Diaz, Elizabeth
NPI: 1336242296 LIC: DN15530
CERTIFICATIONS :
• Inhalation Sedation
#007914
Deborah Austin-Brown DDS PA
420 N. Alexander St
Plant City, FL 33563
(813) 752-5520
Special Needs: No
English, Spanish
T 8am - 4pm
W-Th 8am-4pm
S 8am - 12pm
# DN11764 Austin, Deborah
NPI: 1295884765 LIC: DN11764
CERTIFICATIONS :
#019660
Dental Excellence Partners, LLC
4144 N. Armenia Ave. #150
Tampa, FL 33607
(813) 575-1635
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David*
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie*
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
#022656
Dental Excellence Partners, LLC
807 S. Parson Ave
Brandon, FL 33511
(813) 527-0245
Special Needs: Yes
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
#011013
Great Expressions Dental Centers
825 W. Martin Luther King Blvd
Tampa, FL 33603
(813) 237-1982
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23341 Allawnha, Abdullah
NPI: 1558852392 LIC: DN23341
CERTIFICATIONS :
# DN23122 Beg, Amir
NPI: 1992203707 LIC: DN23122
CERTIFICATIONS :
# DN19709 Biandudi, Odessa
NPI: 1679835599 LIC: DN19709
CERTIFICATIONS :
• Inhalation Sedation
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN12680 Dos Passos II, John
NPI: 1265411953 LIC: DN12680
CERTIFICATIONS :
• Inhalation Sedation
# DN23108 Farrah, Rose
NPI: 1588169254 LIC: DN23108
CERTIFICATIONS :
# DN17010 Howell, Dina
NPI: 1326090200 LIC: DN17010
CERTIFICATIONS :
# DN19638 Immadi, Lakshmi
NPI: 1083988901 LIC: DN19638
CERTIFICATIONS :
# DN22832 Letteri, Nicholas
NPI: 1992237937 LIC: DN22832
CERTIFICATIONS :
# DN22776 Maduro, Ledesha
NPI: 1174982458 LIC: DN22776
CERTIFICATIONS :
# DN15142 Reed, Samantha
NPI: 1104042456 LIC: DN15142
CERTIFICATIONS :
• Inhalation Sedation
# DN19801 Wheeley, Amrita
NPI: 1649533605 LIC: DN19801
CERTIFICATIONS :
#010534
Guillermo Porro, D.M.D., P.A.
7059 West Waters Ave
Tampa, FL 33634
porrodental.com
(813) 889-8599
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN10372 Porro, Guillermo*
NPI: 1346309689 LIC: DN10372
CERTIFICATIONS :
#018023
Happy Family Dental Group, Inc
510 Westbrook Ave
Brandon, FL 33511
(813) 651-0165
Special Needs: No
Creoles and Pidgins
English-based(other), English,
Spanish
M-T 9am-4pm
W-Th 9am-4pm
# DN18899 Botero, Catalina
NPI: 1659513380 LIC: DN18899
CERTIFICATIONS :
• Inhalation Sedation
# DN23107 Giron, Fabiola
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 21 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1780125716 LIC: DN23107
CERTIFICATIONS :
• Inhalation Sedation
# DN23694 Yglesias Ruiz, Erick
NPI: 1427534239 LIC: DN23694
CERTIFICATIONS :
• Inhalation Sedation
#011149
Keystone Dental Excellence
8325 Gunn Hwy
Tampa, FL 33626
(813) 792-0041
Special Needs: No
English, Spanish
M-T 7am-4pm
W-Th 7am-4pm
# DN15969 Reinhart, Joel
NPI: 1033208392 LIC: DN15969
CERTIFICATIONS :
• Inhalation Sedation
#FQHC010979
Palm River Community Health
Center
7728 Palm River Rd
Tampa, FL 33619
(813) 630-3635
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15930 Barlow, Kathleen
NPI: 1164536678 LIC: DN15930
CERTIFICATIONS :
# DN20880 Brachowicz, Maria
NPI: 1770992117 LIC: DN20880
CERTIFICATIONS :
# DN20318 Cisneros, Aura
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN15132 Dietz, Rodney
NPI: 1629326277 LIC: DN15132
CERTIFICATIONS :
# DN16317 Dinh, Lan
NPI: 1568769008 LIC: DN16317
CERTIFICATIONS :
# DN14756 Lee-Loy, Ingrid
NPI: 1144292236 LIC: DN14756
CERTIFICATIONS :
# DN10403 Valdez, Harvey
NPI: 1548325491 LIC: DN10403
CERTIFICATIONS :
#FQHC010832
Plant City Family Care
801 E. Baker Street
Plant City, FL 33563
(813) 653-6100
Special Needs: Yes
English, Spanish
M-T 7am-5pm
W-F 7am-5pm
# DN15930 Barlow, Kathleen*
NPI: 1164536678 LIC: DN15930
CERTIFICATIONS :
# DN20880 Brachowicz, Maria*
NPI: 1770992117 LIC: DN20880
CERTIFICATIONS :
# DN20318 Cisneros, Aura*
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN22362 Colonneaux, Amanda*
NPI: 1073967519 LIC: DN22362
CERTIFICATIONS :
# DN15132 Dietz, Rodney*
NPI: 1629326277 LIC: DN15132
CERTIFICATIONS :
# DN16317 Dinh, Lan*
NPI: 1568769008 LIC: DN16317
CERTIFICATIONS :
# DN14756 Lee-Loy, Ingrid*
NPI: 1144292236 LIC: DN14756
CERTIFICATIONS :
# DN10403 Valdez, Harvey*
NPI: 1548325491 LIC: DN10403
CERTIFICATIONS :
#FQHC010829
Ruskin Health Center
2814 14Th Ave Se
Ruskin, FL 33570
(813) 653-6100
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15930 Barlow, Kathleen
NPI: 1164536678 LIC: DN15930
CERTIFICATIONS :
# DN20880 Brachowicz, Maria
NPI: 1770992117 LIC: DN20880
CERTIFICATIONS :
# DN20318 Cisneros, Aura
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN15132 Dietz, Rodney
NPI: 1629326277 LIC: DN15132
CERTIFICATIONS :
# DN16317 Dinh, Lan
NPI: 1568769008 LIC: DN16317
CERTIFICATIONS :
# DN14756 Lee-Loy, Ingrid
NPI: 1144292236 LIC: DN14756
CERTIFICATIONS :
# DN10403 Valdez, Harvey
NPI: 1548325491 LIC: DN10403
CERTIFICATIONS :
#014571
Sergio M. Lopez, DDS PLLC
3102 W. Waters Ave, Ste 101
Tampa, FL 33614
(813) 374-2441
Special Needs: No
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN18229 Lopez, Sergio
NPI: 1265441125 LIC: DN18229
CERTIFICATIONS :
#FQHC010830
Suncoast Mobile Dental Van
2814 14Th Ave Se
Ruskin, FL 33570
(813) 653-6100
Special Needs: No
English
M-T 8am-5pm
W-F 8am-5pm
# DN15930 Barlow, Kathleen
NPI: 1164536678 LIC: DN15930
CERTIFICATIONS :
# DN20880 Brachowicz, Maria
NPI: 1770992117 LIC: DN20880
CERTIFICATIONS :
# DN20318 Cisneros, Aura
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN15132 Dietz, Rodney
NPI: 1629326277 LIC: DN15132
CERTIFICATIONS :
# DN16317 Dinh, Lan
NPI: 1568769008 LIC: DN16317
CERTIFICATIONS :
# DN14756 Lee-Loy, Ingrid
NPI: 1144292236 LIC: DN14756
CERTIFICATIONS :
# DN10403 Valdez, Harvey
NPI: 1548325491 LIC: DN10403
CERTIFICATIONS :
#FQHC010697
Tampa Family Health Centers
5611 Sheldon Rd
Tampa, FL 33615
(813) 397-5300
Special Needs: Yes
English, Spanish, French (T)
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 22 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
#FQHC022679
Tampa Family Health Centers, Inc
12085 W. Hillsborough Ave
Tampa, FL 33635
(813) 866-0930
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
#FQHC012069
Tampa Family Health Centers,
Inc.
6216 E. Sligh Ave
Tampa, FL 33617
(813) 397-5300
Special Needs: Yes
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
#FQHC012070
Tampa Family Health Centers,
Inc.
302 W. Fletcher Ave
Tampa, FL 33612
tampafamilyhc.com
(813) 397-5305
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC10200
Tampa Family Health Centers,
Inc.
4620 N. 22Nd St
Tampa, FL 33610
tampafamilyhc.com
(813) 397-5300
Special Needs: Yes
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
S 8am - 1pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 23 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC10201
Tampa Family Health Centers,
Inc.
7814 N. Dale Mabry Hwy
Tampa, FL 33614
tampafamilyhc.com
(813) 397-5300
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC10202
Tampa Family Health Centers,
Inc.
1502 E. Fowler Ave
Tampa, FL 33612
tampafamilyhc.com
(813) 397-5300
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC10203
Tampa Family Health Centers,
Inc.
3901 S. West Shore Blvd
Tampa, FL 33611
(813) 397-5300
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC10204
Tampa Family Health Centers,
Inc.
8108 N. Nebraska Ave
Tampa, FL 33604
(813) 397-5300
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 24 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC10205
Tampa Family Health Centers,
Inc.
7608 Causeway Blvd
Tampa, FL 33619
tampafamilyhc.com
(813) 397-5300
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23246 Boodhoo, Amanda
NPI: 1639531460 LIC: DN23246
CERTIFICATIONS :
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23345 Ivanov, Simona
NPI: 1861987752 LIC: DN23345
CERTIFICATIONS :
# DN24211 Jacas, Jose
NPI: 1669032603 LIC: DN24211
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC010833
Tom Lee Community Health
Center
14254 Martin Luther King Blvd S.R.
574
Dover, FL 33527
(813) 349-7736
Special Needs: No
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15930 Barlow, Kathleen
NPI: 1164536678 LIC: DN15930
CERTIFICATIONS :
# DN20880 Brachowicz, Maria
NPI: 1770992117 LIC: DN20880
CERTIFICATIONS :
# DN20318 Cisneros, Aura
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN15132 Dietz, Rodney
NPI: 1629326277 LIC: DN15132
CERTIFICATIONS :
# DN16317 Dinh, Lan
NPI: 1568769008 LIC: DN16317
CERTIFICATIONS :
# DN14756 Lee-Loy, Ingrid
NPI: 1144292236 LIC: DN14756
CERTIFICATIONS :
# HAD70 Simeoni, Anna
NPI: 1396817797 LIC: HAD70
CERTIFICATIONS :
# DN10403 Valdez, Harvey
NPI: 1548325491 LIC: DN10403
CERTIFICATIONS :
ORAL SURGEON
#020259
Dr. Robert Orta D.D.S., P.A
801 W. Dr. Martin Luther Kingjr.
Blvd.
Tampa, FL 33603
ortaoralsugery.com
(813) 238-0411
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN14351 Orta, Robert
NPI: 1376681791 LIC: DN14351
CERTIFICATIONS :
• Inhalation Sedation
#009954
Tampa Bay Institute of Oral
Surgery & Dental Implants
7720 W. Waters Ave
Tampa, FL 33615
www.tampabayos.com
(813) 885-6555
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN18163 Aves, Renato
NPI: 1336322650 LIC: DN18163
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN19301 Caribas-Mendible,
Alejandro
NPI: 1013204122 LIC: DN19301
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN23977 Elmohd, Tarik
NPI: 1538556329 LIC: DN23977
CERTIFICATIONS :
# DN21438 Kalsow, Oleg
NPI: 1275951972 LIC: DN21438
CERTIFICATIONS :
# DN19378 Samaniego, Juan
NPI: 1467692129 LIC: DN19378
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
ORTHODONTIST
#FQHC010832
Plant City Family Care
801 E. Baker Street
Plant City, FL 33563
(813) 653-6100
Special Needs: Yes
English, Spanish
M-T 7am-5pm
W-F 7am-5pm
# DN11575 Chin, Leo*
NPI: 1174731657 LIC: DN11575
CERTIFICATIONS :
• Board Certification
# DN10847 Turke, Eric*
NPI: 1164633483 LIC: DN10847
CERTIFICATIONS :
#FQHC010829
Ruskin Health Center
2814 14Th Ave Se
Ruskin, FL 33570
(813) 653-6100
Special Needs: Yes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 25 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN11575 Chin, Leo
NPI: 1174731657 LIC: DN11575
CERTIFICATIONS :
• Board Certification
# DN10847 Turke, Eric
NPI: 1164633483 LIC: DN10847
CERTIFICATIONS :
#FQHC010830
Suncoast Mobile Dental Van
2814 14Th Ave Se
Ruskin, FL 33570
(813) 653-6100
Special Needs: No
English
M-T 8am-5pm
W-F 8am-5pm
# DN11575 Chin, Leo
NPI: 1174731657 LIC: DN11575
CERTIFICATIONS :
• Board Certification
# DN10847 Turke, Eric
NPI: 1164633483 LIC: DN10847
CERTIFICATIONS :
#FQHC010833
Tom Lee Community Health
Center
14254 Martin Luther King Blvd S.R.
574
Dover, FL 33527
(813) 349-7736
Special Needs: No
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN11575 Chin, Leo
NPI: 1174731657 LIC: DN11575
CERTIFICATIONS :
• Board Certification
# DN10847 Turke, Eric
NPI: 1164633483 LIC: DN10847
CERTIFICATIONS :
PERIODONTICS
#011547
Brandon Mall Dental PA
675 Brandon Town Center Mall
Brandon, FL 33511
(813) 681-8600
Special Needs: Yes
English, Russian, Spanish
T 10am - 4pm
W 10am-5pm, Th 10am-6pm,F
11am-6pm
S 9am - 5pm, Su 10am - 5pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
INDIAN RIVER COUNTY
DENTIST
#013214
Pelican Dental Care, PA
2050 40Th Ave, Ste #6
Vero Beach, FL 32960
(772) 569-9781
Special Needs: No
English, Spanish
M-T 8am-6pm
W-F 8am-6pm
# DN19163 Perez, Liliana*
NPI: 1831402064 LIC: DN19163
CERTIFICATIONS :
#FQHC016045
Treasure Coast Community
Health, Inc
1955 21St Ave
Vero Beach, FL 32960
www.tcchinc.org
(772) 257-8224
Special Needs: Yes
English, Spanish
M 8am - 6pm, T 8am - 5pm
W 8am-5pm, Th 7am-4pm,F 8am-3pm
S 8am - 3pm
# DN23968 Arana, Raisa
NPI: 1386209914 LIC: DN23968
CERTIFICATIONS :
# DN13036 Bongato, Zenaida
NPI: 1922046176 LIC: DN13036
CERTIFICATIONS :
# DN16693 Davis, Robert
NPI: 1770585275 LIC: DN16693
CERTIFICATIONS :
# DN22364 Gaponiuk, Mark
NPI: 1003012212 LIC: DN22364
CERTIFICATIONS :
# DN12337 Knowles, Norman
NPI: 1588766513 LIC: DN12337
CERTIFICATIONS :
• Conscious Sedation
# DN9654 Kronick, Neil
NPI: 1538179528 LIC: DN9654
CERTIFICATIONS :
# 019029133 Marijanovic, Christine
NPI: 1538414073 LIC: 019029133
CERTIFICATIONS :
• Inhalation Sedation
# DN21185 McAndrew, Matthew
NPI: 1194104646 LIC: DN21185
CERTIFICATIONS :
#FQHC7649
Treasure Coast Community
Health, Inc
12196 County Road, # 512
Fellsmere, FL 32948
www.tcchinc.org
(772) 257-8224
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W 7am-4pm, Th 8am-6pm,F 8am-3pm
S 8am - 3pm
# DN23968 Arana, Raisa
NPI: 1386209914 LIC: DN23968
CERTIFICATIONS :
# DN16693 Davis, Robert
NPI: 1770585275 LIC: DN16693
CERTIFICATIONS :
# DN22364 Gaponiuk, Mark
NPI: 1003012212 LIC: DN22364
CERTIFICATIONS :
# HAD63 Kestranek, John
NPI: 1851437354 LIC: HAD63
CERTIFICATIONS :
# DN12337 Knowles, Norman
NPI: 1588766513 LIC: DN12337
CERTIFICATIONS :
• Conscious Sedation
# DN9654 Kronick, Neil
NPI: 1538179528 LIC: DN9654
CERTIFICATIONS :
# 019029133 Marijanovic, Christine
NPI: 1538414073 LIC: 019029133
CERTIFICATIONS :
• Inhalation Sedation
# DN21185 McAndrew, Matthew
NPI: 1194104646 LIC: DN21185
CERTIFICATIONS :
#FQHC7650
Treasure Coast Community
Health, Inc
1545 9Th St Sw
Vero Beach, FL 32962
www.tcchinc.org
(772) 257-8224
Special Needs: Yes
English, Spanish
M 8am - 5pm, T 7am - 4pm
W 8am-6pm, Th 8am-5pm,F 8am-3pm
S 8am - 3pm
# DN23968 Arana, Raisa
NPI: 1386209914 LIC: DN23968
CERTIFICATIONS :
# DN13036 Bongato, Zenaida
NPI: 1922046176 LIC: DN13036
CERTIFICATIONS :
# DN16693 Davis, Robert
NPI: 1770585275 LIC: DN16693
CERTIFICATIONS :
# DN22364 Gaponiuk, Mark
NPI: 1003012212 LIC: DN22364
CERTIFICATIONS :
# DN8390 Goebel, Gerald
NPI: 1245384619 LIC: DN8390
CERTIFICATIONS :
# HAD63 Kestranek, John
NPI: 1851437354 LIC: HAD63
CERTIFICATIONS :
# DN12337 Knowles, Norman
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 26 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1588766513 LIC: DN12337
CERTIFICATIONS :
• Conscious Sedation
# DN9654 Kronick, Neil
NPI: 1538179528 LIC: DN9654
CERTIFICATIONS :
# 019029133 Marijanovic, Christine
NPI: 1538414073 LIC: 019029133
CERTIFICATIONS :
• Inhalation Sedation
# DN21185 McAndrew, Matthew
NPI: 1194104646 LIC: DN21185
CERTIFICATIONS :
JACKSON COUNTY
DENTIST
#FQHC016581
PanCare of Florida, Inc.
4126 Independent Dr.
Marianna, FL 32448
(850) 394-4907
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# DN23419 Lindsay, Sean
NPI: 1477046290 LIC: DN23419
CERTIFICATIONS :
# DN21740 Moffa, Michelle
NPI: 1841277407 LIC: DN21740
CERTIFICATIONS :
# DN19745 Norton, Andrew
NPI: 1861754020 LIC: DN19745
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# DN23084 Santos, Iris
NPI: 1487875233 LIC: DN23084
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
ENDODONTICS
#020298
Larry J. Small DMD Family
Dentistry
2822 Highway 71 Ste H
Marianna, FL 32446
(850) 272-9393
Special Needs: No
English
T 8am - 5pm
W-Th 8am-5pm
# DN10981 Small, Larry
NPI: 1033133475 LIC: DN10981
CERTIFICATIONS :
#FQHC016581
PanCare of Florida, Inc.
4126 Independent Dr.
Marianna, FL 32448
(850) 394-4907
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
ORAL SURGEON
#010535
Oral & Facial Surgery Center of
Marianna
4293 Lafayette St
Marianna, FL 32446
(850) 386-4602
Special Needs: Yes
English, Spanish
W 9am-3pm,
# DN17462 Tolley, Barrett
NPI: 1356362149 LIC: DN17462
CERTIFICATIONS :
• Board Certification
• General Anesthesia
PEDIATRIC DENTISTRY
#010953
Ben Saunders DMD Pediatric
Dentistry
4711 Hwy 90
Marianna, FL 32446
(850) 526-7748
Special Needs: Yes
English
M-T 8am-5pm
W-Th 8am-5pm
# DN14938 Saunders, Stanley
Benjamin*
NPI: 1932123395 LIC: DN14938
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
LAKE COUNTY
DENTIST
#015274
Central Florida Dental Care, LLC
2390 W. Old Hwy 441, Ste 2
Mount Dora, FL 32757
(352) 735-5255
Special Needs: No
English
M-T 9am-5pm
W-F 9am-5pm
# DN12237 Figaro, Mark
NPI: 1952516965 LIC: DN12237
CERTIFICATIONS :
# DN13227 Johary, Carlos
NPI: 1336338755 LIC: DN13227
CERTIFICATIONS :
#018925
Chun In Lin
404 N. Perkins St.
Leesburg, FL 34748
(352) 314-0888
Special Needs: Yes
English, Mandarin Chinese
M-T 8am-4pm
# DN8719 Lin, Chun
NPI: 1568504702 LIC: DN8719
CERTIFICATIONS :
#FQHC022358
Community Health Centers, Inc
225 N. 1St Street
Leesburg, FL 34748
(407) 905-8827
Special Needs: No
M 8am - 5pm, T 8am - 7pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 27 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#FQHC014606
Community Health Centers, Inc.
212 E. Main St
Tavares, FL 32778
(407) 905-8827
Special Needs: Yes
English, Spanish
M 8am - 6pm, T 8am - 7pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#CHC10282
DOH - Lake County Health
Department
875 Oakley Seaver Dr
Clermont, FL 34711
(352) 989-9001
Special Needs: Yes
English
M 9am - 6pm,
# DN19269 Caraballo, Enid
NPI: 1225178973 LIC: DN19269
CERTIFICATIONS :
# DN11984 Gonzalez, Jose
NPI: 1992706691 LIC: DN11984
CERTIFICATIONS :
# DN11385 Traul Jr., Robert
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
#016498
Jeff Molloy DDS PA
820 W Montrose Street
Clermont, FL 34711
(352) 394-4567
Special Needs: No
English
M-T 8am-5pm
W-F 8am-5pm
# DN21435 Molloy, Jeffrey*
NPI: 1821209990 LIC: DN21435
CERTIFICATIONS :
#022844
Leesburg Smiles LLC
8301 County Road 44 Leg A
Leesburg, FL 34788
(352) 504-0659
Special Needs: Yes
English, Arabic, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17585 Mousa, Ammar
NPI: 1962413781 LIC: DN17585
CERTIFICATIONS :
#FQHC7969
South Lake Dental (Community
Health Ctr)
1296 W. Broad Street
Groveland, FL 34736
(407) 905-8827
Special Needs: Yes
Spanish
M-T 8am-6pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania*
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 28 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina*
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
LEE COUNTY
DENTIST
#MCHC014635
DOH- Florida Department of
Health - Lee County (Mobile Unit)
3920 Michigan Ave
Fort Myers, FL 33916
(239) 332-9569
Special Needs: No
English, Spanish
M-T 9am-4pm
W-F 9am-4pm
# DN11385 Traul Jr., Robert*
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
#011545
Edison Mall Dental PA
4125 Cleveland Ave Ste 1430
Fort Myers, FL 33901
(239) 939-9050
Special Needs: Yes
English, Russian, Spanish
M-T 10am-5pm
W-F 10am-5pm
S 10am - 4pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#021857
Happy Smiles of Fort Myers
2675 Winkler Ave, Unit 150
Fort Myers, FL 33901
happysmilesfortmyers.com
(239) 204-2780
Special Needs: Yes
English, Russian, Spanish
M 10am - 5pm, T 9am - 5pm
W 9am-5pm, Th 9am-4pm,F 9am-3pm
# DN23676 Aldaya, Robair
NPI: 1508344599 LIC: DN23676
CERTIFICATIONS :
# DN23633 Andrade, Emily
NPI: 1407335409 LIC: DN23633
CERTIFICATIONS :
# DN20845 Bradley, Alijah*
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward*
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
CERTIFICATIONS :
# DN17996 Etemadshahidi, Babak*
NPI: 1336300805 LIC: DN17996
CERTIFICATIONS :
# DN24425 Faizzadeh, Paula
NPI: 1912550799 LIC: DN24425
CERTIFICATIONS :
# DN23511 Nguyen, Chi*
NPI: 1811482656 LIC: DN23511
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 29 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
• Inhalation Sedation
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
# DN24429 Shahriari, Varahram
NPI: 1952954778 LIC: DN24429
CERTIFICATIONS :
# DN16481 Zadov, Marianna
NPI: 1104903301 LIC: DN16481
CERTIFICATIONS :
• Inhalation Sedation
#022536
Lee Bella Dental
6844 International Center Blvd, Ste A
Fort Myers, FL 33912
(239) 691-8380
Special Needs: Yes
English, Spanish
M-T 9am-4pm
W-F 9am-4pm
# DN21607 Velasquez-Pierce,
Ximena*
NPI: 1548606874 LIC: DN21607
CERTIFICATIONS :
#010481
Picasso Aesthetic & Cosmetic
Dental Spa
9776 Bonita Beach Road Ste 202A
Bonita Springs, FL 34135
(239) 405-3997
Special Needs: Yes
English
M-T 9am-5pm
W-F 9am-5pm
# DN12852 Rubin, Jeffrey*
NPI: 1073520789 LIC: DN12852
CERTIFICATIONS :
#007731
Rapident
3722 Central Ave, Ste #1
Ft Myers, FL 33901
(239) 274-7687
Special Needs: Yes
English, Spanish
M-T 10am-5pm
W-Th 10am-5pm
# DN13261 Putzeys, Rodolfo*
NPI: 1578697553 LIC: DN13261
CERTIFICATIONS :
PERIODONTICS
#011545
Edison Mall Dental PA
4125 Cleveland Ave Ste 1430
Fort Myers, FL 33901
(239) 939-9050
Special Needs: Yes
English, Russian, Spanish
M-T 10am-5pm
W-F 10am-5pm
S 10am - 4pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
#021857
Happy Smiles of Fort Myers
2675 Winkler Ave, Unit 150
Fort Myers, FL 33901
happysmilesfortmyers.com
(239) 204-2780
Special Needs: Yes
English, Russian, Spanish
M 10am - 5pm, T 9am - 5pm
W 9am-5pm, Th 9am-4pm,F 9am-3pm
# DN23115 Mendoza, Juan
NPI: 1821326430 LIC: DN23115
CERTIFICATIONS :
• Inhalation Sedation
# DN11699 Simon, David
NPI: 1508303587 LIC: DN11699
CERTIFICATIONS :
• Oral / Enteral Sedation
LEON COUNTY
DENTIST
#FQHC010635
Bond Community Health Center,
Inc.
1720 S. Gadsden St, Ste 219
Tallahassee, FL 32301
(850) 521-5121
Special Needs: Yes
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# DN9380 Manocha, Ashok
NPI: 1467669606 LIC: DN9380
CERTIFICATIONS :
# DN7339 Tolley, Leonard
NPI: 1902822497 LIC: DN7339
CERTIFICATIONS :
#FQHC014446
Neighborhood Medical Center Inc.
872 W.Orange Ave
Tallahassee, FL 32310
www.neighborhoodmedicalcenter.org
(850) 577-0435
Special Needs: Yes
English, Spanish, Swahili
M-T 7am-6pm
W-F 7am-6pm
# DN15616 Abreu, Romelio
NPI: 1568639268 LIC: DN15616
CERTIFICATIONS :
# DN22475 Butler, Latoya
NPI: 1003357351 LIC: DN22475
CERTIFICATIONS :
# HAD84 Hall, Shai
NPI: 1013043637 LIC: HAD84
CERTIFICATIONS :
# DN20236 Laing, Christopher
NPI: 1356696272 LIC: DN20236
CERTIFICATIONS :
# DN18939 Thiry, Warren
NPI: 1477871697 LIC: DN18939
CERTIFICATIONS :
# DN20886 Wells, Rachelle
NPI: 1588858286 LIC: DN20886
CERTIFICATIONS :
• Inhalation Sedation
#FQHC018638
Neighborhood Medical Center Inc.
3013 Jim Lee Road
Tallahassee, FL 32301
www.neighborhoodmedicalcenter.org
(850) 224-2469
Special Needs: Yes
English, Spanish
M-T 7am-6pm
W-F 7am-6pm
# DN15616 Abreu, Romelio
NPI: 1568639268 LIC: DN15616
CERTIFICATIONS :
# DN22475 Butler, Latoya
NPI: 1003357351 LIC: DN22475
CERTIFICATIONS :
# HAD84 Hall, Shai
NPI: 1013043637 LIC: HAD84
CERTIFICATIONS :
# DN20236 Laing, Christopher
NPI: 1356696272 LIC: DN20236
CERTIFICATIONS :
# DN18939 Thiry, Warren
NPI: 1477871697 LIC: DN18939
CERTIFICATIONS :
# DN20886 Wells, Rachelle
NPI: 1588858286 LIC: DN20886
CERTIFICATIONS :
• Inhalation Sedation
MANATEE COUNTY
DENTIST
#014072
Greenberg Dental & Orthodontics
8446 Lockwood Ridge Rd
Sarasota, FL 34243
(941) 312-2024
Special Needs: Yes
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# DN17729 Sainsbury, James*
NPI: 1235342650 LIC: DN17729
CERTIFICATIONS :
#FQHC015357
Lawton Chiles Dental
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 30 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
1515 26Th Ave East
Bradenton, FL 34208
(941) 708-7607
Special Needs: Yes
English, Spanish
M 8am - 8pm, T 8am - 5pm
W-F 8am-5pm
# DN5615 Acquaro, Ronald
NPI: 1558409169 LIC: DN5615
CERTIFICATIONS :
• Pediatric Conscious Sedation
# DN21300 Alonso, Anamevys
NPI: 1669868147 LIC: DN21300
CERTIFICATIONS :
# DN19659 Cherry, Jerry
NPI: 1700172129 LIC: DN19659
CERTIFICATIONS :
# DN18543 Keo, Phanith
NPI: 1285828491 LIC: DN18543
CERTIFICATIONS :
# DN13120 Martinez, Susana
NPI: 1215015144 LIC: DN13120
CERTIFICATIONS :
# DN24605 Potts-Williams, Madge
NPI: 1902028780 LIC: DN24605
CERTIFICATIONS :
# DN19389 Sanchez, Arnaldo
NPI: 1831486844 LIC: DN19389
CERTIFICATIONS :
#011168
LeCom School of Dental Medicine
4800 Lakewood Ranch Blvd
Bradenton, FL 34211
(941) 405-1600
Special Needs: Yes
English, Arabic, Russian, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN12523 Lipton, Barry
NPI: 1689676918 LIC: DN12523
CERTIFICATIONS :
# DN19387 Manibo, Lourdes
Alexandra
NPI: 1730312760 LIC: DN19387
CERTIFICATIONS :
# DN8944 Ottenga, Marc
NPI: 1306802293 LIC: DN8944
CERTIFICATIONS :
• Inhalation Sedation
# DTP651 Supczenski, John
NPI: 1538159934 LIC: DTP651
CERTIFICATIONS :
#M013843
Manatee County Rural Health
Serv, - Health Express (Mobile)
12271 Us Hwy 301 N
Parrish, FL 34219
(941) 713-2081
Special Needs: Yes
English
# DN21300 Alonso, Anamevys
NPI: 1669868147 LIC: DN21300
CERTIFICATIONS :
# DN19659 Cherry, Jerry
NPI: 1700172129 LIC: DN19659
CERTIFICATIONS :
# DN18543 Keo, Phanith
NPI: 1285828491 LIC: DN18543
CERTIFICATIONS :
# DN13120 Martinez, Susana
NPI: 1215015144 LIC: DN13120
CERTIFICATIONS :
# DN14205 Melean, Alfonso
NPI: 1609845031 LIC: DN14205
CERTIFICATIONS :
# DN24605 Potts-Williams, Madge
NPI: 1902028780 LIC: DN24605
CERTIFICATIONS :
# DN19389 Sanchez, Arnaldo
NPI: 1831486844 LIC: DN19389
CERTIFICATIONS :
#FQHC015356
Manatee Village Dental Center
1312 Manatee Ave East
Bradenton, FL 34208
(941) 708-8710
Special Needs: Yes
English, Spanish
M 8am - 8pm, T 8am - 5pm
Th-F 8am-5pm
# DN5615 Acquaro, Ronald
NPI: 1558409169 LIC: DN5615
CERTIFICATIONS :
• Pediatric Conscious Sedation
# DN21300 Alonso, Anamevys
NPI: 1669868147 LIC: DN21300
CERTIFICATIONS :
# DN19659 Cherry, Jerry
NPI: 1700172129 LIC: DN19659
CERTIFICATIONS :
# DN18543 Keo, Phanith
NPI: 1285828491 LIC: DN18543
CERTIFICATIONS :
# DN13120 Martinez, Susana
NPI: 1215015144 LIC: DN13120
CERTIFICATIONS :
# DN14205 Melean, Alfonso
NPI: 1609845031 LIC: DN14205
CERTIFICATIONS :
# DN24605 Potts-Williams, Madge
NPI: 1902028780 LIC: DN24605
CERTIFICATIONS :
# DN19389 Sanchez, Arnaldo
NPI: 1831486844 LIC: DN19389
CERTIFICATIONS :
#020059
Montiel Dental Care PA
6818 14Th St W
Bradenton, FL 34207
(941) 782-8058
Special Needs: No
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
S 9am - 6pm
# DN23640 Moreno Montiel, Yuliet
NPI: 1841786647 LIC: DN23640
CERTIFICATIONS :
#011207
Ward Family Dental, PA
1619 Tallevast Road
Tallevast, FL 34270
(941) 355-4800
Special Needs: Yes
English, Spanish, French
M-T 4pm-7pm
W-Th 4pm-7pm
S 9am - 1pm
# DN5019 Ward, Clifford*
NPI: 1386856615 LIC: DN5019
CERTIFICATIONS :
# DN17405 Ward, Tasha*
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
ORAL SURGEON
#014072
Greenberg Dental & Orthodontics
8446 Lockwood Ridge Rd
Sarasota, FL 34243
(941) 312-2024
Special Needs: Yes
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# DN16923 Lawson, Scott*
NPI: 1467470781 LIC: DN16923
CERTIFICATIONS :
• Board Certification
• General Anesthesia
• Inhalation Sedation
MARION COUNTY
DENTIST
#CHC10191
DOH - Marion County Health
Department
1501 W Silver Springs Blvd
Ocala, FL 34475
(352) 622-2664
Special Needs: Yes
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN11663 Bridges, Catherine
NPI: 1659309821 LIC: DN11663
CERTIFICATIONS :
# 23871 Miller, Howard
NPI: 1538159363 LIC: 23871
CERTIFICATIONS :
# DN21699 Spenn, Jonathan
NPI: 1942435318 LIC: DN21699
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 31 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
#FQHC011141
Heart of Florida Health Center
1025 Sw 1St Ave
Ocala, FL 34471
(352) 732-6599
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23944 Batista, Claudia
NPI: 1447747449 LIC: DN23944
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN24041 Fantin-Yusta, Carlotta*
NPI: 1164991600 LIC: DN24041
CERTIFICATIONS :
# DN15057 Greenwald, Lara
NPI: 1417126699 LIC: DN15057
CERTIFICATIONS :
#FQHC013562
Heart of Florida Health Center Inc
255 Se 17Th St
Ocala, FL 34471
www.myhfhc.org
(352) 274-9731
Special Needs: Yes
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN23944 Batista, Claudia
NPI: 1447747449 LIC: DN23944
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN24041 Fantin-Yusta, Carlotta
NPI: 1164991600 LIC: DN24041
CERTIFICATIONS :
# DN15057 Greenwald, Lara
NPI: 1417126699 LIC: DN15057
CERTIFICATIONS :
#FQHC10256
Langley Health Services
7205 Se Maricamp Rd
Ocala, FL 34472
(352) 680-7011
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19878 Clinton, Edna
NPI: 1376853929 LIC: DN19878
CERTIFICATIONS :
• Inhalation Sedation
# DN21667 Pirie, Edward
NPI: 1255705752 LIC: DN21667
CERTIFICATIONS :
# DN15250 Vavruska, Julie
NPI: 1992798649 LIC: DN15250
CERTIFICATIONS :
• Inhalation Sedation
# DN14803 Worthy, Michele
NPI: 1023196169 LIC: DN14803
CERTIFICATIONS :
• Inhalation Sedation
MARTIN COUNTY
DENTIST
#FQHC020246
Florida Community Health
Centers, Inc.
15858 Sw Warfield Blvd
Indiantown, FL 34956
www.fchcinc.org
(772) 597-3596
Special Needs: Yes
English, Spanish
M 8am - 6pm, T 8am - 5pm
W-Th 8am-5pm
# DN20720 Blackwood, Alberto
NPI: 1487057303 LIC: DN20720
CERTIFICATIONS :
# DN13607 Morales, Carlos
NPI: 1457310559 LIC: DN13607
CERTIFICATIONS :
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN23400 Pham, Emily
NPI: 1851947568 LIC: DN23400
CERTIFICATIONS :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
# DN13207 Zayas, Alida
NPI: 1639148968 LIC: DN13207
CERTIFICATIONS :
#FQHC020248
Florida Community Health
Centers, Inc.
3441 Se Willoughby Blvd
Stuart, FL 34994
(772) 403-5650
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M 8am - 6pm, T 8am - 5pm
W-Th 8am-5pm
# DN20720 Blackwood, Alberto
NPI: 1487057303 LIC: DN20720
CERTIFICATIONS :
# DN13607 Morales, Carlos
NPI: 1457310559 LIC: DN13607
CERTIFICATIONS :
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN23400 Pham, Emily
NPI: 1851947568 LIC: DN23400
CERTIFICATIONS :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
# DN13207 Zayas, Alida
NPI: 1639148968 LIC: DN13207
CERTIFICATIONS :
MIAMI-DADE COUNTY
DENTIST
#011900
A & R Dental Center of Hialeah
765 E 9 St
Hialeah, FL 33010
(305) 883-4880
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN19137 Cuenca, Annie
NPI: 1871806273 LIC: DN19137
CERTIFICATIONS :
# DN19107 Rodriguez, Rene
NPI: 1942513122 LIC: DN19107
CERTIFICATIONS :
#007543
AB Dentistry Inc
9840 Sw 40Th St
Miami, FL 33165
(305) 223-0420
Special Needs: Yes
English, Spanish
M 9am - 6pm, T 9am - 1pm
F 9am-1pm
# DN16665 Betancourt, Arely
NPI: 1265528897 LIC: DN16665
CERTIFICATIONS :
#013660
Ace Smiles Dental Associates
14138 Sw 8Th St Ste #1
Miami, FL 33184
(786) 717-7779
Special Needs: Yes
English, Spanish, French
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN18576 Mendoza, Irenia
NPI: 1124256920 LIC: DN18576
CERTIFICATIONS :
• Inhalation Sedation
#021748
Acuario Dental Group
4355 W. 16 Ave, Ste 205A
Hialeah, FL 33012
(786) 800-9507
Special Needs: Yes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 32 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish
M 9am - 7pm, T 9am - 2pm
W-Th 9am-7pm
S 9am - 3pm
# DN14821 Ayala, Rita
NPI: 1619090289 LIC: DN14821
CERTIFICATIONS :
#013231
Adolfo E. Mares Dental Office
306 Sw 12Ave, Ste B
Miami, FL 33130
(305) 642-0535
Special Needs: Yes
Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN12527 Mares, Adolfo
NPI: 1811048937 LIC: DN12527
CERTIFICATIONS :
#009021
Aladino Valiente, DMD, PA
12781 Sw 42Nd Street, Ste D
Miami, FL 33175
www.valientedental.com
(305) 226-7404
Special Needs: Yes
Spanish, English
M-T 9am-7pm
W-F 9am-7pm
# DN15599 Valiente, Aladino
NPI: 1609935626 LIC: DN15599
CERTIFICATIONS :
#009529
Alejandro De La Cruz, D.D.S., P.A.
7380 Sw 40 St, Ste B
Miami, FL 33155
(305) 441-2773
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN14560 De la Cruz, Alejandro
NPI: 1013152016 LIC: DN14560
CERTIFICATIONS :
#013603
Alicia B. Cayon, D.M.D., P.A.
8370 W Flagler St Ste 150
Miami, FL 33144
(305) 227-3083
Special Needs: No
English, Spanish
M 11am - 6pm, T 9am - 5pm
Th-F 9am-5pm
S 9am - 2pm
# DN20679 Cayon, Alicia
NPI: 1467865022 LIC: DN20679
CERTIFICATIONS :
#007563
All Family Care Inc
38 Nw 8Th St
Homestead, FL 33030
(305) 246-0460
Special Needs: Yes
English, Spanish, French
M 11am - 7pm, T 9am - 5pm
W 11am-7pm,
# DN12529 Martinez, Jose
NPI: 1780798926 LIC: DN12529
CERTIFICATIONS :
# DN12244 Sanchez, Jorge
NPI: 1568636280 LIC: DN12244
CERTIFICATIONS :
#016126
All In One Dental Services
13728 Sw 84Th Street
Miami, FL 33183
www.aiodentist.com
(305) 456-7383
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 10am - 3pm
# DN14821 Ayala, Rita
NPI: 1619090289 LIC: DN14821
CERTIFICATIONS :
# DN11609 Herdocia, Filiberto
NPI: 1750788030 LIC: DN11609
CERTIFICATIONS :
# DN17506 Mora, Yosjany
NPI: 1922179613 LIC: DN17506
CERTIFICATIONS :
#012970
Alpha Dental Group
4999 W 8 Ave Ste 1
Hialeah, FL 33012
(786) 953-5943
Special Needs: No
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN14173 Bobadilla, Patricia
NPI: 1124039672 LIC: DN14173
CERTIFICATIONS :
#021615
Alpha Dental Group 2
5870 Sw 8 Street, Ste 4
Miami, FL 33144
(305) 392-1261
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN14173 Bobadilla, Patricia
NPI: 1124039672 LIC: DN14173
CERTIFICATIONS :
# DN23695 Cruz, Yanet
NPI: 1508225376 LIC: DN23695
CERTIFICATIONS :
#006690
Amaury Rodriguez, DDS
3944 W. Flagler Street
Miami, FL 33134
(305) 445-1405
Special Needs: Yes
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN12779 Rodriguez, Amaury
NPI: 1437251568 LIC: DN12779
CERTIFICATIONS :
#014267
Amazing Touch Dental Care Corp
1955 W. 68Th St
Hialeah, FL 33014
(786) 257-1646
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN11884 Soler, Rosa
NPI: 1083738652 LIC: DN11884
CERTIFICATIONS :
#013162
America Dental Clinic
3631 Sw 87Th Ave
Miami, FL 33165
(305) 485-8427
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN20289 Soto Mendez, Lisbet
NPI: 1679915953 LIC: DN20289
CERTIFICATIONS :
# DN17931 Toirac, Maria
NPI: 1790987543 LIC: DN17931
CERTIFICATIONS :
#012979
Aponte Dental Corp
1350 Sw 57 Ave Ste 106
Miami, FL 33144
(305) 265-6120
Special Needs: No
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN20182 Aponte-Barrios, Secil
NPI: 1164714176 LIC: DN20182
CERTIFICATIONS :
#021793
A-Z Dental Inc
5924 West 16Th Ave
Hialeah, FL 33012
(305) 558-2133
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 33 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 5pm
# DN14173 Bobadilla, Patricia
NPI: 1124039672 LIC: DN14173
CERTIFICATIONS :
#008228
Becerra's Family Dentistry
936 Sw 82Nd Ave Ste 936
Miami, FL 33144
(305) 269-1440
Special Needs: Yes
English, Spanish
M 9am - 6pm, T 8am - 8pm
W 9am-5pm, Th 9am-6pm,F 9am-5pm
# DN15934 Becerra, Maria
NPI: 1598841405 LIC: DN15934
CERTIFICATIONS :
#012298
Best Family Dental
5190 Nw 167 St #216
Miami Gardens, FL 33014
(305) 624-4114
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN12269 Blay, Marina
NPI: 1932425972 LIC: DN12269
CERTIFICATIONS :
# DN6340 Drobes, David
NPI: 1740478221 LIC: DN6340
CERTIFICATIONS :
#CHC8227
Borinquen Health Care Center,
INC
3601 Federal Hwy, 5Th Floor
Miami, FL 33137
(305) 576-6611
Special Needs: Yes
English, Spanish, Creoles and Pidgins
Portuguese-based(other), French,
Persian (T), Portuguese
M-T 8am-5pm
W 8am-5pm, Th 8am-6pm,F 8am-4pm
S 8am - 2pm
# DN19140 Mestre, Jairo
NPI: 1811202971 LIC: DN19140
CERTIFICATIONS :
• Inhalation Sedation
# DN19249 Pria, Carlos
NPI: 1811166838 LIC: DN19249
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DN16074 Soheil, Michelle
NPI: 1215014394 LIC: DN16074
CERTIFICATIONS :
#FQHC017137
Borinquen Health Care Center,
Inc.
708 Ne 125Th St
North Miami, FL 33161
(305) 576-6611
Special Needs: Yes
English, Farsi, French, Spanish
M-T 8am-5pm
W-Th 8am-5pm
S 8am - 2pm
# DN19249 Pria, Carlos
NPI: 1811166838 LIC: DN19249
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DN16074 Soheil, Michelle
NPI: 1215014394 LIC: DN16074
CERTIFICATIONS :
#018293
Broward Mall Dental
1334 Sw 1St St
Miami, FL 33135
(305) 230-4426
Special Needs: Yes
M-T 8am-4pm
W-F 8am-4pm
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
#011430
C & C Dental, Inc.
951 Ne 167 Street, #104
North Miami Beach, FL 33162
(305) 493-9371
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN19495 Casas, Silvia
NPI: 1912295387 LIC: DN19495
CERTIFICATIONS :
#FQHC012553
Camillus Health Concern, Inc.
336 Nw 5Th St
Miami, FL 33128
(305) 341-0152
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN9529 Alfonso, Rafael
NPI: 1669546784 LIC: DN9529
CERTIFICATIONS :
# DN24503 Cole, Eric
NPI: 1265848881 LIC: DN24503
CERTIFICATIONS :
# DN15957 De la Torre, Carmen
NPI: 1093892150 LIC: DN15957
CERTIFICATIONS :
#016489
Care Resource
1901 Sw 1St St
Miami, FL 33135
(305) 203-5230
Special Needs: Yes
English
M-T 8am-5pm
Th-F 8am-5pm
# DN13731 Barnes, Curtis
NPI: 1689798936 LIC: DN13731
CERTIFICATIONS :
# DN18139 Casas, Manuel
NPI: 1740420090 LIC: DN18139
CERTIFICATIONS :
# DN20973 Martinez, Amy
NPI: 1124382866 LIC: DN20973
CERTIFICATIONS :
# DN20674 Sardinas, Yoan
NPI: 1992118657 LIC: DN20674
CERTIFICATIONS :
#CHC13129
Care Resource Community Health
Centers
3510 Biscayne Blvd, Ste 300
Miami, FL 33137
(305) 576-1234
Special Needs: Yes
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
# DN13731 Barnes, Curtis*
NPI: 1689798936 LIC: DN13731
CERTIFICATIONS :
# DN18139 Casas, Manuel*
NPI: 1740420090 LIC: DN18139
CERTIFICATIONS :
# DN20973 Martinez, Amy*
NPI: 1124382866 LIC: DN20973
CERTIFICATIONS :
# DN20674 Sardinas, Yoan*
NPI: 1992118657 LIC: DN20674
CERTIFICATIONS :
#006607
Cecilia Maria Rey, DDS PA
4790 Nw 7Th Street, Ste 210/211
Miami, FL 33126
(305) 448-2014
Special Needs: No
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 34 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN14776 Rey, Cecilia
NPI: 1588872006 LIC: DN14776
CERTIFICATIONS :
#FQHC016391
CFCE Pediatric & Family Health
& Wellness
1825 Nw 167 St Ste 102
Miami Gardens, FL 33056
(305) 474-1800
Special Needs: Yes
English, Spanish, Creoles and Pidgins
(other)
M 9am - 5pm, T 10am - 7pm
Th-F 9am-5pm
# DN21844 Brunet, Zeida
NPI: 1093164956 LIC: DN21844
CERTIFICATIONS :
# DN21846 Fonseca, Jacqueline
NPI: 1487005369 LIC: DN21846
CERTIFICATIONS :
#008230
Ciro A. Martin, DDS, PA
8463 Bird Road
Miami, FL 33155
(305) 551-6714
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN13508 Martin, Ciro
NPI: 1093855256 LIC: DN13508
CERTIFICATIONS :
#011421
Claudio L. Miro DDS
564 Sw 42 Ave, 2Nd Floor
Miami, FL 33134
(305) 442-7444
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN21293 Merikas, Amanda
NPI: 1669853305 LIC: DN21293
CERTIFICATIONS :
# DN11650 Miro, Claudio
NPI: 1417024118 LIC: DN11650
CERTIFICATIONS :
• Conscious Sedation
# DN16786 Miro, Kiara
NPI: 1427078625 LIC: DN16786
CERTIFICATIONS :
# DN16862 Trujillo, Alexander
NPI: 1043231996 LIC: DN16862
CERTIFICATIONS :
• Conscious Sedation
#FQHC7698
Clinica Campesina
810 West Mowry Dr.
Homestead, FL 33030
(305) 242-6078
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M 8am - 7pm, T 8am - 5pm
W 8am-7pm, Th 8am-5pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#019446
Collazo Family Dental
285 Nw 27Th Ave Ste 21
Miami, FL 33125
(786) 238-7590
Special Needs: Yes
English, Spanish
M 10am - 6pm,
S 10am - 2pm
# DN20751 Ramos Collazo, Yoaris
NPI: 1679982748 LIC: DN20751
CERTIFICATIONS :
#FQHC7697
Community Health Center
10300 Sw 216Th Street
Miami, FL 33190
(305) 253-5100
Special Needs: Yes
English, Chinese Mandarin, Creoles
and Pidgins English-based(other),
French, Polish, Spanish
M-T 8am-7pm
W-Th 8am-7pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN22552 Ramirez Gonzalez,
Carmen
NPI: 1134659543 LIC: DN22552
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#FQHC014565
Community Health of South
Florida, Inc.
13540 Sw 135 Ave
Miami, FL 33186
www.chisouthfl.org
(786) 231-0800
Special Needs: Yes
English, Spanish
T 8am - 6pm
W-F 8am-6pm
S 8am - 12pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 35 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#FQHC014566
Community Health of South
Florida, Inc.
6350 Sunset Drive
Miami, FL 33143
(786) 293-5500
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M 8am - 5pm, T 10am - 7pm
W 8am-5pm, Th 10am-7pm,F
8am-5pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#022054
Coral Gables Dental Health
Center
747 Ponce De Leon Blvd, Ste 401
Miami, FL 33134
(305) 444-8591
Special Needs: No
English, Spanish
M-T 10am-7pm
W-Th 10am-7pm
# DN16140 Carballo, Rodolfo
NPI: 1235466269 LIC: DN16140
CERTIFICATIONS :
#007940
Crown Dental Corp
10728 Sw 72Nd Street
Miami, FL 33173
(305) 596-7155
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 1pm
# DN12593 Gonzalez, Lilian
NPI: 1255436424 LIC: DN12593
CERTIFICATIONS :
#011899
D & R Dentistry
14750 Sw 26 St Ste 210
Miami, FL 33185
(305) 400-8060
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN18940 Rodriguez, Ramon
NPI: 1366768657 LIC: DN18940
CERTIFICATIONS :
#009364
David E Dewitt, DDS PA
4841 W 4Th Ave
Hialeah, FL 33012
(305) 558-2261
Special Needs: Yes
Spanish, English
M 9am - 5pm, T 9am - 6pm
Th-F 9am-2pm
S 9am - 12pm
# DN3920 Dewitt, David
NPI: 1548372139 LIC: DN3920
CERTIFICATIONS :
# DN8463 Vazana, Raphael
NPI: 1528170107 LIC: DN8463
CERTIFICATIONS :
#011412
David M. Adelman, DDS, PA
16680 Ne 10Th Ave
North Miami Beach, FL 33162
(305) 944-6669
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN3881 Adelman, David
NPI: 1215053160 LIC: DN3881
CERTIFICATIONS :
• Inhalation Sedation
#015505
De La Calle Dental Center
10775 Sw 56Th St
Miami, FL 33165
delacalledentalcenter@gmail.com
(305) 321-5927
Special Needs: No
English, Spanish
T 9am - 5pm
W-F 9am-5pm
# DN21153 Lobaina, Karina
NPI: 1063895076 LIC: DN21153
CERTIFICATIONS :
#014323
Deluxe Dental
4005 Sw 152Nd Ave Unit 2
Miami, FL 33185
(786) 409-5295
Special Needs: No
English, Spanish
M 10am - 6pm, T 1pm - 9pm
W-Th 10am-6pm
# DN20362 Diaz, Farah
NPI: 1861784779 LIC: DN20362
CERTIFICATIONS :
#015414
Dental Dreams LLC
5632 Nw 167Th St
Miami, FL 33014
(305) 625-9777
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W 9am-5pm,
S 9am - 1pm
# DN16291 Carpio, Jesus
NPI: 1932281961 LIC: DN16291
CERTIFICATIONS :
#019648
Dental Excellence Partners, LLC
4500 Nw 7Th St
Miami, FL 33126
(305) 443-9206
Special Needs: Yes
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 36 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#019649
Dental Excellence Partners, LLC
8300 W. Flager Ste 210
Miami, FL 33144
(786) 534-2796
Special Needs: Yes
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
#019657
Dental Excellence Partners, LLC
3825 W. 16Th Ave
Hialeah, FL 33012
(786) 501-2166
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#019658
Dental Excellence Partners, LLC
6801 Sw 8Th St.
Miami, FL 33144
(786) 501-2168
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#019659
Dental Excellence Partners, LLC
4410 W. 16Th Ave #58
Hialeah, FL 33012
(305) 826-5224
Special Needs: Yes
English, Spanish
M-T 8am-5pm
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 37 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
W-F 8am-5pm
# DN20182 Aponte-Barrios, Secil
NPI: 1164714176 LIC: DN20182
CERTIFICATIONS :
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#020098
Dental Excellence Partners, LLC
266 E 49Th St
Hialeah, FL 33013
(305) 823-9982
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN23886 Castellanos, Nicholas
NPI: 1497228621 LIC: DN23886
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#020099
Dental Excellence Partners, LLC
5190 Nw 167Th Ave Ste 109
Miami Lakes, FL 33014
(786) 507-3454
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#020101
Dental Excellence Partners, LLC
13768 Sw 8Th St
Miami, FL 33184
(786) 501-2163
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN24104 Gonzalez Junco, Luis
NPI: 1447819396 LIC: DN24104
CERTIFICATIONS :
# DN23700 Gonzalez, Carmen
NPI: 1285110718 LIC: DN23700
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19802 Hernandez, David
NPI: 1245593896 LIC: DN19802
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 38 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#009925
Dental Group of Miami Beach
1010 71 Street
Miami Beach, FL 33141
(305) 868-8500
Special Needs: Yes
English, Spanish
M 10am - 7pm, T 9am - 4pm
W-Th 10am-7pm
# DN19274 Quintana, Vilma
NPI: 1598064354 LIC: DN19274
CERTIFICATIONS :
#008978
Dental Group of South Florida II,
Inc
11336 Sw 184Th St
Miami, FL 33157
(305) 251-4262
Special Needs: Yes
English, Spanish
M-T 9am-7pm
W 9am-7pm, Th 9am-7am,F 9am-6pm
# DN20905 Rodriguez Castro, Miriam
NPI: 1992051700 LIC: DN20905
CERTIFICATIONS :
#012990
Dental Plus Inc.
11352 Quail Roost Dr
Miami, FL 33157
(305) 969-2651
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
S 9am - 2pm
# DN19504 Cordova-Pena, Noris*
NPI: 1669754578 LIC: DN19504
CERTIFICATIONS :
#012876
Diana R. Blanco, DMD, PLLC
279 Nw 82 Ave
Miami, FL 33126
(305) 456-4592
Special Needs: Yes
M-T 10am-6pm
W-F 10am-6pm
S 9am - 3pm
# DN18471 Blanco, Diana
NPI: 1659536043 LIC: DN18471
CERTIFICATIONS :
#CHC012593
DOH - Miami Dade Jefferson
Reeves Clinic
1009 Nw 5Th Ave
Miami, FL 33136
(786) 845-0164
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN12747 Martin, Rosa*
NPI: 1538373428 LIC: DN12747
CERTIFICATIONS :
# DN17940 Subirats-Torres, Ibelys*
NPI: 1811193972 LIC: DN17940
CERTIFICATIONS :
#CHC014620
DOH - Miami-Dade County
Health Department
971 Nw 2Nd St
Miami, FL 33128
(305) 575-3800
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN12747 Martin, Rosa
NPI: 1538373428 LIC: DN12747
CERTIFICATIONS :
# DN17940 Subirats-Torres, Ibelys
NPI: 1811193972 LIC: DN17940
CERTIFICATIONS :
#016275
Dr. Jauregui Dental Care Corp
5757 Sw 8Th Street, Ste 115
Miami, FL 33144
wwwdrjauregui
(305) 269-1781
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21055 Jauregui, Guillermo
NPI: 1124375647 LIC: DN21055
CERTIFICATIONS :
#012061
Dr. Jean-Jacques Edderai, DDS PA
17101 Ne 19Th Ave, Ste 104
North Miami Beach, FL 33162
(305) 947-7999
Special Needs: Yes
English, Spanish, French, Hebrew
M-T 9am-5pm
W 9am-5pm, Th 12pm-7pm,F
9am-1pm
# DN12836 Edderai, Jean
NPI: 1598981227 LIC: DN12836
CERTIFICATIONS :
#021124
Dr. Zmiles Inc.
2999 Ne 191 St. Ste #602
Aventura, FL 33180
dr-zsmiles.com
(305) 682-1795
Special Needs: Yes
English, Russian, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN18673 Trujillo, Zuzel
NPI: 1285860353 LIC: DN18673
CERTIFICATIONS :
#008240
Edy A. Guerra, DDS
4011 West Flagler Street, Ste #506
Miami, FL 33134
(305) 643-1444
Special Needs: No
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN13559 Guerra, Edy
NPI: 1174749691 LIC: DN13559
CERTIFICATIONS :
#012702
Elizabeth De Aguirre DDS
806 S Douglas Rd Ste 150
Coral Gables, FL 33134
(305) 446-2226
Special Needs: Yes
English, Spanish
M 9am - 5pm, T 9am - 6pm
W-Th 9am-6pm
# DN15008 De Aguirre, Elizabeth
NPI: 1467434746 LIC: DN15008
CERTIFICATIONS :
#008275
Elizabeth De Aguirre, D.D.S., P.A.
2750 W. 68 St, Ste 108
Hialeah, FL 33016
(305) 826-3255
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN17647 Bueno, Rosa
NPI: 1972649218 LIC: DN17647
CERTIFICATIONS :
• Inhalation Sedation
# DN15008 De Aguirre, Elizabeth
NPI: 1467434746 LIC: DN15008
CERTIFICATIONS :
#017955
Empire Corporation
2030 Nw 22Nd Ave
Miami, FL 33142
(305) 631-2963
Special Needs: No
English, Spanish
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 39 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
M-T 9am-5pm
W-F 9am-5pm
# DN14173 Bobadilla, Patricia
NPI: 1124039672 LIC: DN14173
CERTIFICATIONS :
# DN21847 Diaz, Jany
NPI: 1659729598 LIC: DN21847
CERTIFICATIONS :
#008286
Enrique Morales, DDS, PC
3009 East 4Th Ave
Hialeah, FL 33013
(305) 691-1616
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN14003 Morales, Enrique
NPI: 1649310319 LIC: DN14003
CERTIFICATIONS :
#FQHC7694
Everglades Health Center
19300 Sw 376Th St
Homestead, FL 33034
(305) 246-4607
Special Needs: Yes
English, Chinese Mandarin, Creoles
and Pidgins English-based(other),
French, Polish, Spanish
W 8am-6pm,
S 8am - 12pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#011876
Excellence in Dental Care
3762 W 12Th Ave
Hialeah, FL 33012
(305) 557-6661
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W 9am-6am, Th 9am-6pm,F 9am-1pm
# DN17118 Alvarez, Rosa
NPI: 1306944533 LIC: DN17118
CERTIFICATIONS :
#009426
Family and Cometic Dentistry
4300 W. Flagler St Ste 201
Miami, FL 33134
(305) 888-0008
Special Needs: Yes
English, Spanish
M-T 11am-6pm
W 11am-6pm, Th 9am-6pm,F
11am-6pm
S 9am - 3pm
# DN23163 Castro, Eileen
NPI: 1518348796 LIC: DN23163
CERTIFICATIONS :
# DN21994 Cortes Morales,
Guillermo
NPI: 1912359266 LIC: DN21994
CERTIFICATIONS :
# DN22100 Corugedo, Ada
NPI: 1568814747 LIC: DN22100
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
CERTIFICATIONS :
# DN21579 Garcia, Idalmes
NPI: 1245675107 LIC: DN21579
CERTIFICATIONS :
# DN21977 Garrote, Rogelio
NPI: 1144671470 LIC: DN21977
CERTIFICATIONS :
# DN13322 Gomara, Luis
NPI: 1659381879 LIC: DN13322
CERTIFICATIONS :
# DN21830 Guerra-Crespa, Beatriz
NPI: 1376960658 LIC: DN21830
CERTIFICATIONS :
# DN18680 Hernandez-Baco, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN24153 Kucharski, Melanie
NPI: 1265086060 LIC: DN24153
CERTIFICATIONS :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
CERTIFICATIONS :
# DN22539 Narvaez, Veronica
NPI: 1366979270 LIC: DN22539
CERTIFICATIONS :
# DN22276 Pena-Marro, Blanca
NPI: 1043620099 LIC: DN22276
CERTIFICATIONS :
# DN21249 Prieto, Evelyn
NPI: 1598146755 LIC: DN21249
CERTIFICATIONS :
# DN21179 Reyes Canal, Osmil
NPI: 1356732275 LIC: DN21179
CERTIFICATIONS :
# DN13492 Salcines, Damaris
NPI: 1891705091 LIC: DN13492
CERTIFICATIONS :
# DN23323 Sanchez, Marlie
NPI: 1891287462 LIC: DN23323
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
# DN20482 Valdes, Martha
NPI: 1649605585 LIC: DN20482
CERTIFICATIONS :
# DN24491 Zerquis Molina, Manuel
NPI: 1598205718 LIC: DN24491
CERTIFICATIONS :
#009424
Family and Cosmetic Dentistry
125 Ne 8Th St Ste 1
Homestead, FL 33030
(305) 245-6458
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN23163 Castro, Eileen
NPI: 1518348796 LIC: DN23163
CERTIFICATIONS :
# DN21994 Cortes Morales,
Guillermo
NPI: 1912359266 LIC: DN21994
CERTIFICATIONS :
# DN22100 Corugedo, Ada
NPI: 1568814747 LIC: DN22100
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
CERTIFICATIONS :
# DN21579 Garcia, Idalmes
NPI: 1245675107 LIC: DN21579
CERTIFICATIONS :
# DN21977 Garrote, Rogelio
NPI: 1144671470 LIC: DN21977
CERTIFICATIONS :
# DN13322 Gomara, Luis
NPI: 1659381879 LIC: DN13322
CERTIFICATIONS :
# DN21830 Guerra-Crespa, Beatriz
NPI: 1376960658 LIC: DN21830
CERTIFICATIONS :
# DN18680 Hernandez-Baco, Karen
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 40 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN24153 Kucharski, Melanie
NPI: 1265086060 LIC: DN24153
CERTIFICATIONS :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
CERTIFICATIONS :
# DN22539 Narvaez, Veronica
NPI: 1366979270 LIC: DN22539
CERTIFICATIONS :
# DN22276 Pena-Marro, Blanca
NPI: 1043620099 LIC: DN22276
CERTIFICATIONS :
# DN21249 Prieto, Evelyn
NPI: 1598146755 LIC: DN21249
CERTIFICATIONS :
# DN21179 Reyes Canal, Osmil
NPI: 1356732275 LIC: DN21179
CERTIFICATIONS :
# DN13492 Salcines, Damaris
NPI: 1891705091 LIC: DN13492
CERTIFICATIONS :
# DN23323 Sanchez, Marlie
NPI: 1891287462 LIC: DN23323
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
# DN20482 Valdes, Martha
NPI: 1649605585 LIC: DN20482
CERTIFICATIONS :
# DN24491 Zerquis Molina, Manuel
NPI: 1598205718 LIC: DN24491
CERTIFICATIONS :
#009425
Family and Cosmetic Dentistry
13706 Sw 56Th St Ste 201
Miami, FL 33175
www.familyplusdentalcenters.com
(305) 387-4954
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN23163 Castro, Eileen
NPI: 1518348796 LIC: DN23163
CERTIFICATIONS :
# DN21994 Cortes Morales,
Guillermo
NPI: 1912359266 LIC: DN21994
CERTIFICATIONS :
# DN22100 Corugedo, Ada
NPI: 1568814747 LIC: DN22100
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
CERTIFICATIONS :
# DN21579 Garcia, Idalmes
NPI: 1245675107 LIC: DN21579
CERTIFICATIONS :
# DN21977 Garrote, Rogelio
NPI: 1144671470 LIC: DN21977
CERTIFICATIONS :
# DN13322 Gomara, Luis
NPI: 1659381879 LIC: DN13322
CERTIFICATIONS :
# DN21830 Guerra-Crespa, Beatriz
NPI: 1376960658 LIC: DN21830
CERTIFICATIONS :
# DN18680 Hernandez-Baco, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN24153 Kucharski, Melanie
NPI: 1265086060 LIC: DN24153
CERTIFICATIONS :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
CERTIFICATIONS :
# DN22539 Narvaez, Veronica
NPI: 1366979270 LIC: DN22539
CERTIFICATIONS :
# DN22276 Pena-Marro, Blanca
NPI: 1043620099 LIC: DN22276
CERTIFICATIONS :
# DN21249 Prieto, Evelyn
NPI: 1598146755 LIC: DN21249
CERTIFICATIONS :
# DN21179 Reyes Canal, Osmil
NPI: 1356732275 LIC: DN21179
CERTIFICATIONS :
# DN13492 Salcines, Damaris
NPI: 1891705091 LIC: DN13492
CERTIFICATIONS :
# DN23323 Sanchez, Marlie
NPI: 1891287462 LIC: DN23323
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
# DN20482 Valdes, Martha
NPI: 1649605585 LIC: DN20482
CERTIFICATIONS :
# DN24491 Zerquis Molina, Manuel
NPI: 1598205718 LIC: DN24491
CERTIFICATIONS :
#009428
Family and Cosmetic Dentistry
2900 W. 12Th Ave Ste 27
Hialeah, FL 33012
(786) 800-0171
Special Needs: Yes
English, Spanish
M-T 11am-7pm
W 9am-6pm, Th 11am-7pm,F
9am-6pm
S 8am - 3pm
# DN23163 Castro, Eileen
NPI: 1518348796 LIC: DN23163
CERTIFICATIONS :
# DN21994 Cortes Morales,
Guillermo
NPI: 1912359266 LIC: DN21994
CERTIFICATIONS :
# DN22100 Corugedo, Ada
NPI: 1568814747 LIC: DN22100
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
CERTIFICATIONS :
# DN21579 Garcia, Idalmes
NPI: 1245675107 LIC: DN21579
CERTIFICATIONS :
# DN21977 Garrote, Rogelio
NPI: 1144671470 LIC: DN21977
CERTIFICATIONS :
# DN13322 Gomara, Luis
NPI: 1659381879 LIC: DN13322
CERTIFICATIONS :
# DN21830 Guerra-Crespa, Beatriz
NPI: 1376960658 LIC: DN21830
CERTIFICATIONS :
# DN18680 Hernandez-Baco, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN24153 Kucharski, Melanie
NPI: 1265086060 LIC: DN24153
CERTIFICATIONS :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
CERTIFICATIONS :
# DN22539 Narvaez, Veronica
NPI: 1366979270 LIC: DN22539
CERTIFICATIONS :
# DN22276 Pena-Marro, Blanca
NPI: 1043620099 LIC: DN22276
CERTIFICATIONS :
# DN21249 Prieto, Evelyn
NPI: 1598146755 LIC: DN21249
CERTIFICATIONS :
# DN21179 Reyes Canal, Osmil
NPI: 1356732275 LIC: DN21179
CERTIFICATIONS :
# DN13492 Salcines, Damaris
NPI: 1891705091 LIC: DN13492
CERTIFICATIONS :
# DN23323 Sanchez, Marlie
NPI: 1891287462 LIC: DN23323
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
# DN20482 Valdes, Martha
NPI: 1649605585 LIC: DN20482
CERTIFICATIONS :
# DN24491 Zerquis Molina, Manuel
NPI: 1598205718 LIC: DN24491
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 41 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
#022660
Family and Cosmetic Dentistry
432 Nw 12Th Ave
Miami, FL 33128
(305) 387-4954
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 2pm
# DN23163 Castro, Eileen
NPI: 1518348796 LIC: DN23163
CERTIFICATIONS :
# DN21994 Cortes Morales,
Guillermo
NPI: 1912359266 LIC: DN21994
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
CERTIFICATIONS :
# DN21579 Garcia, Idalmes
NPI: 1245675107 LIC: DN21579
CERTIFICATIONS :
# DN21977 Garrote, Rogelio
NPI: 1144671470 LIC: DN21977
CERTIFICATIONS :
# DN13322 Gomara, Luis
NPI: 1659381879 LIC: DN13322
CERTIFICATIONS :
# DN24153 Kucharski, Melanie
NPI: 1265086060 LIC: DN24153
CERTIFICATIONS :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN21249 Prieto, Evelyn
NPI: 1598146755 LIC: DN21249
CERTIFICATIONS :
# DN21179 Reyes Canal, Osmil
NPI: 1356732275 LIC: DN21179
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
# DN20482 Valdes, Martha
NPI: 1649605585 LIC: DN20482
CERTIFICATIONS :
#022715
Family and Cosmetic Dentistry
1437 Ne 1St Ter
Homestead, FL 33030
(305) 387-4954
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN23163 Castro, Eileen
NPI: 1518348796 LIC: DN23163
CERTIFICATIONS :
# DN21994 Cortes Morales,
Guillermo
NPI: 1912359266 LIC: DN21994
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
CERTIFICATIONS :
# DN21579 Garcia, Idalmes
NPI: 1245675107 LIC: DN21579
CERTIFICATIONS :
# DN21977 Garrote, Rogelio
NPI: 1144671470 LIC: DN21977
CERTIFICATIONS :
# DN13322 Gomara, Luis
NPI: 1659381879 LIC: DN13322
CERTIFICATIONS :
# DN21830 Guerra-Crespa, Beatriz
NPI: 1376960658 LIC: DN21830
CERTIFICATIONS :
# DN18680 Hernandez-Baco, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN24153 Kucharski, Melanie
NPI: 1265086060 LIC: DN24153
CERTIFICATIONS :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN22276 Pena-Marro, Blanca
NPI: 1043620099 LIC: DN22276
CERTIFICATIONS :
# DN21249 Prieto, Evelyn
NPI: 1598146755 LIC: DN21249
CERTIFICATIONS :
# DN21179 Reyes Canal, Osmil
NPI: 1356732275 LIC: DN21179
CERTIFICATIONS :
# DN23323 Sanchez, Marlie
NPI: 1891287462 LIC: DN23323
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
# DN20482 Valdes, Martha
NPI: 1649605585 LIC: DN20482
CERTIFICATIONS :
#012059
Felicita Marquez Iglesias, DDS
4890 W. 3Rd Ave
Hialeah, FL 33012
(305) 826-0906
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 1pm
# DN20430 Marquez-Iglesias, Felicita
NPI: 1740619402 LIC: DN20430
CERTIFICATIONS :
#008287
Feoli Dental
1490 Ne Miami Garden Drive
Miami Gardens, FL 33179
www.feolidental.com
(305) 949-5252
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 9am-6pm
W-Th 9am-6pm
S 9am - 2pm
# DN20757 Castillo, Sandra
NPI: 1245636133 LIC: DN20757
CERTIFICATIONS :
# DN18037 Feoli, Carmen
NPI: 1013199819 LIC: DN18037
CERTIFICATIONS :
#010735
Fermin R. Lopez D.D.S PA Corp
1125 Nw 22Nd Ave
Miami, FL 33125
(305) 649-6112
Special Needs: No
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 3pm
# DN14996 Beydoun, Miriam*
NPI: 1902012669 LIC: DN14996
CERTIFICATIONS :
# DN23490 Chirino, Carlos*
NPI: 1184118077 LIC: DN23490
CERTIFICATIONS :
# DN24362 Cortes Fontanet, Raisa*
NPI: 1124505268 LIC: DN24362
CERTIFICATIONS :
# DN23695 Cruz, Yanet*
NPI: 1508225376 LIC: DN23695
CERTIFICATIONS :
# DN24481 Defaus, Beatriz*
NPI: 1023558087 LIC: DN24481
CERTIFICATIONS :
# DN24480 El Ghannam, Isis*
NPI: 1316487531 LIC: DN24480
CERTIFICATIONS :
# DN22369 Lastra-Perez, Annette*
NPI: 1942745385 LIC: DN22369
CERTIFICATIONS :
# DN19848 Ramos, Yilian*
NPI: 1699030205 LIC: DN19848
CERTIFICATIONS :
#015430
Flagler Dental Care LLC
1199 W. Flagler St, Ste 7
Miami, FL 33130
(305) 324-5072
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN19770 Hernandez, Daynet
NPI: 1336469121 LIC: DN19770
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 42 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN24424 Vazquez Grillo, Lissandra
NPI: 1952831711 LIC: DN24424
CERTIFICATIONS :
#013440
Flores Dental Group
11890 Sw 8Th Street, Ste #300
Miami, FL 33184
(305) 485-0072
Special Needs: Yes
English, Spanish
T 9am - 7pm
W-Th 9am-7pm
# DN117660 Flores, Joan
NPI: 1962604488 LIC: DN117660
CERTIFICATIONS :
• Inhalation Sedation
#FQHC022784
Floridental Clinic
9240 Sw 72Nd Street, Ste 115
Miami, FL 33173
(305) 595-0557
Special Needs: Yes
English, Spanish
T 9am - 6pm
W 9am-6pm,
# DN22851 Garcia, Lisset
NPI: 1487036216 LIC: DN22851
CERTIFICATIONS :
#023118
Fortune Smiles Dental
1843 Sw 8Th Street
Miami, FL 33135
(786) 542-0977
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
#016316
G.S. Dental
15640 Sw 72Nd St
Miami, FL 33193
(305) 200-3404
Special Needs: Yes
English, Spanish
M-T 9am-4pm
W-F 9am-4pm
S 9am - 1pm
# DN20771 Sague, Gustavo*
NPI: 1699177964 LIC: DN20771
CERTIFICATIONS :
#016124
Gary Alvo DDS
16600 Ne 8Th Ave
Miami, FL 33162
(305) 944-3441
Special Needs: No
English, Farsi, Spanish
M-T 7am-3pm
S 8am - 2pm
# DN7805 Alvo, Gary
NPI: 1518997451 LIC: DN7805
CERTIFICATIONS :
#006638
Gateway Dental
2375 Sw 27Th Ave
Miami, FL 33145
www.gatewaydentalinc.com
(305) 856-2300
Special Needs: Yes
Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN18302 Herrera, Victoria
NPI: 1114185550 LIC: DN18302
CERTIFICATIONS :
# DN15212 Miranda, Pablo
NPI: 1023036365 LIC: DN15212
CERTIFICATIONS :
# DN15477 Perrotti, Steven
NPI: 1144249780 LIC: DN15477
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
#010098
Gateway Dental
1050 Nw 14Th Street, 2Nd Floor, Ste
204
Miami, FL 33136
www.gatewaydentalinc.com
(305) 856-2300
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN18302 Herrera, Victoria
NPI: 1114185550 LIC: DN18302
CERTIFICATIONS :
# DN15212 Miranda, Pablo
NPI: 1023036365 LIC: DN15212
CERTIFICATIONS :
# DN15477 Perrotti, Steven
NPI: 1144249780 LIC: DN15477
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
#017005
Gateway Dental
1400 Ne Miami Gardens Dr. Ste 201
North Miami Beach, FL 33179
(305) 856-2300
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN18302 Herrera, Victoria
NPI: 1114185550 LIC: DN18302
CERTIFICATIONS :
# DN15212 Miranda, Pablo
NPI: 1023036365 LIC: DN15212
CERTIFICATIONS :
# DN15477 Perrotti, Steven
NPI: 1144249780 LIC: DN15477
CERTIFICATIONS :
# DN22991 Santiesteban, Aymara
NPI: 1265826168 LIC: DN22991
CERTIFICATIONS :
#022816
Gentle Teeth of Kendall
6670 Sw 117 Ave
Miami, FL 33183
(305) 595-3400
Special Needs: Yes
English, Spanish
M-T 8am-8pm
W-F 8am-8pm
S 8am - 8pm
# DN22652 Perez, Annabel
NPI: 1932639283 LIC: DN22652
CERTIFICATIONS :
#022744
Great Dental Expressions Inc
568 Hialeah Drive
Hialeah, FL 33010
(305) 835-0123
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 5pm
# DN22223 Fiffe, Eliseo
NPI: 1760737480 LIC: DN22223
CERTIFICATIONS :
#013364
Hammocks Dental Center, PA
9280 Hammock Blvd, Ste #102
Miami, FL 33196
(305) 387-5700
Special Needs: Yes
Spanish
M 12pm - 6pm, T 9am - 3pm
W 2pm-6pm, Th 12pm-6pm
S 10am - 1pm
# DN19377 Calderon, Erik
NPI: 1942596416 LIC: DN19377
CERTIFICATIONS :
• Inhalation Sedation
#011734
Happy Teeth Dental, LLC
7976 Sw 8Th St
Miami, FL 33144
(305) 266-4544
Special Needs: Yes
English, Spanish
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 43 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
M 2pm - 7pm, T 9am - 6pm
W 11am-6pm, Th 9am-6pm,F
9am-5pm
# DN16431 Rodriguez, Alejandro
NPI: 1942386305 LIC: DN16431
CERTIFICATIONS :
#012647
Health and Cosmetic Dental Care
4150 Nw 7Th St Ste 103
Miami, FL 33126
(305) 646-9222
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN19927 Rodriguez, Gretell
NPI: 1154678910 LIC: DN19927
CERTIFICATIONS :
#017698
Healthy Smile
9016 Nw 25Th St.
Miami, FL 33172
(786) 671-0174
Special Needs: No
English, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN16963 Figueredo, Maria
NPI: 1144313602 LIC: DN16963
CERTIFICATIONS :
#007623
Hialeah Dental Associates
2106 W. 68Th St
Hialeah, FL 33016
(305) 827-6661
Special Needs: No
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN13520 Mendez, Antonio
NPI: 1659570430 LIC: DN13520
CERTIFICATIONS :
# DN20271 Monzon, Lucrecia
NPI: 1477975399 LIC: DN20271
CERTIFICATIONS :
#013236
Hialeah Dental Care, Inc
4240 West 16Th Ave
Hialeah, FL 33012
(305) 823-1882
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21433 Iduate Banobre, Yolanda
NPI: 1598140618 LIC: DN21433
CERTIFICATIONS :
# DN17094 Rodriguez, Roxana
NPI: 1336263912 LIC: DN17094
CERTIFICATIONS :
# DN11884 Soler, Rosa
NPI: 1083738652 LIC: DN11884
CERTIFICATIONS :
#010839
Hialeah Dental Center
750 East 25Th Street
Hialeah, FL 33013
(305) 694-5400
Special Needs: Yes
English, Arabic, Chinese Mandarin,
Portuguese, Romanian, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN8062 Mulkay, Esteban
NPI: 1184784423 LIC: DN8062
CERTIFICATIONS :
# DN19606 Souza, Rodrigo
NPI: 1891958146 LIC: DN19606
CERTIFICATIONS :
#007981
Hialeah Dental Center, PA
1518 West 49Th Street
Hialeah, FL 33012
www.dentilife.com
(305) 823-2661
Special Needs: Yes
English, Spanish
M-T 12pm-8pm
W-Th 12pm-8pm
S 10am - 2pm
# DN19377 Calderon, Erik
NPI: 1942596416 LIC: DN19377
CERTIFICATIONS :
• Inhalation Sedation
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#011423
Hialeah Miro Office Corp.
320 W 49 Street
Hialeah, FL 33012
www.mirodentalcenter.com
(305) 685-7494
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN11650 Miro, Claudio
NPI: 1417024118 LIC: DN11650
CERTIFICATIONS :
• Conscious Sedation
# DN16862 Trujillo, Alexander
NPI: 1043231996 LIC: DN16862
CERTIFICATIONS :
• Conscious Sedation
#013560
Homestead Family Dental Care
809 Ne 4Th Ave
Homestead, FL 33030
(305) 248-3961
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN19770 Hernandez, Daynet
NPI: 1336469121 LIC: DN19770
CERTIFICATIONS :
# DN24424 Vazquez Grillo, Lissandra
NPI: 1952831711 LIC: DN24424
CERTIFICATIONS :
#012974
Honest Dental Service
400 Sw 27 Ave
Miami, FL 33135
(305) 456-8046
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN20070 Sepulveda, Isabel
NPI: 1790111763 LIC: DN20070
CERTIFICATIONS :
#010312
Hutchinson-Dental
100 Nw 170Th Street Ste 306
North Miami, FL 33169
(786) 235-5120
Special Needs: No
Creoles and Pidgins
French-based(other), English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN19291 Hutchinson, Paula
NPI: 1801196936 LIC: DN19291
CERTIFICATIONS :
#008271
Idalmes Perez DDS, PA.
1141 Palm Ave
Hialeah, FL 33010
(305) 888-8555
Special Needs: Yes
English, Spanish
M-T 9am-6pm
Th-F 9am-6pm
# DN22185 Gonzalez, Darlen
NPI: 1649623034 LIC: DN22185
CERTIFICATIONS :
# DN17928 Perez, Idalmes
NPI: 1881896306 LIC: DN17928
CERTIFICATIONS :
#009808
J.M. Dental Group Inc.
1470 Nw 107Th Ave, Ste F-G
Miami, FL 33172
(305) 594-8666
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W 9am-6pm, Th 9am-5pm,F 9am-4pm
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 44 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN20566 Del Castillo, Raymond
NPI: 1609212091 LIC: DN20566
CERTIFICATIONS :
# DN22217 Echeverri, Jonathan
NPI: 1104371137 LIC: DN22217
CERTIFICATIONS :
# DN14451 Hernandez, Norberto
NPI: 1285693267 LIC: DN14451
CERTIFICATIONS :
#008892
Jadent Inc.
3945 Sw 92 Ave
Miami, FL 33165
(305) 220-0066
Special Needs: Yes
Spanish
M-T 10am-7pm
W-F 10am-7pm
S 10am - 3pm
# DN14047 Arocha, Josefina
NPI: 1952448367 LIC: DN14047
CERTIFICATIONS :
# DN21384 Guevara, Anaely
NPI: 1184007932 LIC: DN21384
CERTIFICATIONS :
#FQHC018872
Jessie Trice Community Health
Center, Inc
217 Nw 15Th Street
Miami, FL 33136
(305) 637-6400
Special Needs: Yes
Creoles and Pidgins
English-based(other), English,
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN11213 Barcia, Antonio
NPI: 1306052626 LIC: DN11213
CERTIFICATIONS :
# DN23140 Feiz, Maria
NPI: 1932615929 LIC: DN23140
CERTIFICATIONS :
# DN12903 George, Deborah
NPI: 1720149180 LIC: DN12903
CERTIFICATIONS :
# DN21713 Lebron, Vanessa
NPI: 1619336369 LIC: DN21713
CERTIFICATIONS :
# DN10368 Perdigon-Cangahuala,
Nitza
NPI: 1720006174 LIC: DN10368
CERTIFICATIONS :
• Inhalation Sedation
#FQHC015997
Jessie Trice Community Health
Center, Inc.
901 E. 10Th Ave, Bay #39
Hialeah, FL 33010
(305) 637-6400
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M 10am - 6pm,
# DN11213 Barcia, Antonio
NPI: 1306052626 LIC: DN11213
CERTIFICATIONS :
# DN23140 Feiz, Maria
NPI: 1932615929 LIC: DN23140
CERTIFICATIONS :
# DN12903 George, Deborah
NPI: 1720149180 LIC: DN12903
CERTIFICATIONS :
# DN21713 Lebron, Vanessa
NPI: 1619336369 LIC: DN21713
CERTIFICATIONS :
# DN10368 Perdigon-Cangahuala,
Nitza
NPI: 1720006174 LIC: DN10368
CERTIFICATIONS :
• Inhalation Sedation
#FQHC016404
Jessie Trice Community Health
Center, Inc.
490 Opa-Locka Blvd
Opa Locka, FL 33054
(305) 637-6400
Special Needs: Yes
English
M-T 8am-5pm
W 8am-5pm, Th 8am-6pm,F 8am-5pm
# DN11213 Barcia, Antonio
NPI: 1306052626 LIC: DN11213
CERTIFICATIONS :
# DN23140 Feiz, Maria
NPI: 1932615929 LIC: DN23140
CERTIFICATIONS :
# DN12903 George, Deborah
NPI: 1720149180 LIC: DN12903
CERTIFICATIONS :
# DN21713 Lebron, Vanessa
NPI: 1619336369 LIC: DN21713
CERTIFICATIONS :
# DN10368 Perdigon-Cangahuala,
Nitza
NPI: 1720006174 LIC: DN10368
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9796
Jessie Trice Community Health
Center, Inc.
5361 N.W. 22Nd Ave
Miami, FL 33142
(305) 637-6400
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 8am-5pm
W-F 8am-5pm
# DN11213 Barcia, Antonio
NPI: 1306052626 LIC: DN11213
CERTIFICATIONS :
# DN23140 Feiz, Maria
NPI: 1932615929 LIC: DN23140
CERTIFICATIONS :
# DN12903 George, Deborah
NPI: 1720149180 LIC: DN12903
CERTIFICATIONS :
# DN21713 Lebron, Vanessa
NPI: 1619336369 LIC: DN21713
CERTIFICATIONS :
# DN10368 Perdigon-Cangahuala,
Nitza
NPI: 1720006174 LIC: DN10368
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9797
Jessie Trice Community Health
Center, Inc.
5607 Nw 27Th Ave, Ste 2
Miami, FL 33142
(305) 637-6400
Special Needs: No
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 7am-6pm
W-F 7am-6pm
# DN11213 Barcia, Antonio
NPI: 1306052626 LIC: DN11213
CERTIFICATIONS :
# DN23140 Feiz, Maria
NPI: 1932615929 LIC: DN23140
CERTIFICATIONS :
# DN12903 George, Deborah
NPI: 1720149180 LIC: DN12903
CERTIFICATIONS :
# DN21713 Lebron, Vanessa
NPI: 1619336369 LIC: DN21713
CERTIFICATIONS :
# DN10368 Perdigon-Cangahuala,
Nitza
NPI: 1720006174 LIC: DN10368
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9799
Jessie Trice Community Health
Center, Inc.
18360 N.W. 7Th Ave
Miami, FL 33169
(305) 637-6400
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 8am-5pm
W-F 8am-5pm
S 9am - 2pm
# DN11213 Barcia, Antonio
NPI: 1306052626 LIC: DN11213
CERTIFICATIONS :
# DN23140 Feiz, Maria
NPI: 1932615929 LIC: DN23140
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 45 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN12903 George, Deborah
NPI: 1720149180 LIC: DN12903
CERTIFICATIONS :
# DN21713 Lebron, Vanessa
NPI: 1619336369 LIC: DN21713
CERTIFICATIONS :
# DN10368 Perdigon-Cangahuala,
Nitza
NPI: 1720006174 LIC: DN10368
CERTIFICATIONS :
• Inhalation Sedation
#007902
Jose R. Geno, DMD
2200 Sw 16Th Street, Ste 202
Miami, FL 33145
(305) 854-8707
Special Needs: Yes
English, Spanish
M-T 9am-6pm
Th-F 9am-6pm
S 10am - 3pm
# DN10499 Geno, Jose
NPI: 1942496658 LIC: DN10499
CERTIFICATIONS :
#011384
Joseph S. Gay, D.D.S.
18063 Nw 27Th Ave
Miami Gardens, FL 33056
(305) 625-3747
Special Needs: Yes
English
M-T 9am-5pm
W 11am-7pm, Th 9am-12pm,F
7am-1pm
# DN5710 Gay, Joseph
NPI: 1114084639 LIC: DN5710
CERTIFICATIONS :
#011427
Jossue Alfonso DMD PA
351 Nw 42Nd Ave, Ste 402
Miami, FL 33126
(305) 642-4142
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN19316 Alfonso, Jossue
NPI: 1235423997 LIC: DN19316
CERTIFICATIONS :
#013606
JR Dental Office INC.
6847 W. 4Th Ave
Hialeah, FL 33014
(786) 431-5000
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W 10am-7pm, Th 9am-6pm,F
10am-7pm
# DN20920 De Quesada, Diana
NPI: 1992105688 LIC: DN20920
CERTIFICATIONS :
# DN12018 Marini, Nohelia
NPI: 1568640852 LIC: DN12018
CERTIFICATIONS :
#012608
Jubidental Services Corp
299 Alhambra Circle, Ste 202
Miami, FL 33134
(305) 444-3074
Special Needs: No
English, Spanish
M-T 11am-5pm
W-F 8am-3pm
# DN20131 Cotelo-Pardo, Yanepsi
NPI: 1881986891 LIC: DN20131
CERTIFICATIONS :
#019686
Kendall Dental & Implant Center
13055 Sw 42Nd St Ste #206
Miami, FL 33175
kendalldentalimplant.com
(305) 846-9669
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W 8am-5pm, Th 8am-8pm,F 8am-5pm
S 9am - 2pm
# DN18984 Garcia, Delio
NPI: 1790006823 LIC: DN18984
CERTIFICATIONS :
#011104
Kendall Wood Park Dental Center
12001 Sw 128 Court, Ste 204
Miami, FL 33186
www.prodentalcenters.com
(305) 330-9261
Special Needs: Yes
English, Spanish
M-T 9am-5pm
Th-F 9am-5pm
S 9am - 1pm
# DN17100 Corrales-Iglesias, Luisa
NPI: 1861546277 LIC: DN17100
CERTIFICATIONS :
#018216
Kindly Dental
18652 Nw 67Th Ave, Ste 27
Hialeah, FL 33015
www.nsdclinic.com
(305) 474-0400
Special Needs: No
English, Spanish
M-T 9am-5pm
Th-F 9am-5pm
S 8am - 1pm
# DN20258 Garcia Lopez, Dorgis
NPI: 1992147326 LIC: DN20258
CERTIFICATIONS :
#017577
Latin Quarter Dental PA
1660 Sw 1St St
Miami, FL 33135
(305) 642-8499
Special Needs: Yes
English, Spanish
M-T 9am-2pm
W-F 9am-2pm
S 7am - 2pm
# DN19240 Lea Plaza, Rodolfo
NPI: 1932407103 LIC: DN19240
CERTIFICATIONS :
#012706
Lemus Dental Group
5171 Sw 8Th St
Miami, FL 33134
(305) 567-0236
Special Needs: Yes
English, Spanish
M 10am - 7pm, T 9am - 5pm
W 10am-7pm, Th 9am-5pm,F
10am-3pm
# DN20326 Lemus, Isel
NPI: 1033541537 LIC: DN20326
CERTIFICATIONS :
#008948
Lobaina Dental
8822 Sw 24Th St
Miami, FL 33165
lobainadental.com
(305) 480-9838
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN18774 Lobaina, Yoan
NPI: 1245468131 LIC: DN18774
CERTIFICATIONS :
# DN20781 Perez, Zaily
NPI: 1063828929 LIC: DN20781
CERTIFICATIONS :
#009614
Lobaina Dental
30 Nw 15 Street
Homestead, FL 33030
lobainadental.com
(305) 245-9691
Special Needs: Yes
English, Spanish
M-T 9am-4pm
W-F 9am-4pm
# DN18774 Lobaina, Yoan
NPI: 1245468131 LIC: DN18774
CERTIFICATIONS :
#012095
Luis M. Santamarina, D.M.D.
330 Sw 27Th Ave Ste 602
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 46 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Miami, FL 33135
(305) 644-3464
Special Needs: Yes
Spanish, English, German
M 9am - 12pm, T 9am - 5pm
W-Th 9am-5pm
# DN8610 Santamarina, Luis
NPI: 1427157320 LIC: DN8610
CERTIFICATIONS :
#008355
Manuel E. Costa, DDS
791 E. 48Th St
Hialeah, FL 33013
(305) 769-0252
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 12pm
# DN8736 Costa, Manuel
NPI: 1659495307 LIC: DN8736
CERTIFICATIONS :
#011394
Maria Hernandez, DDS
2500 Sw 107 Ave, Ste #45
Miami, FL 33165
(305) 223-5439
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN12595 Hernandez, Maria
NPI: 1902846967 LIC: DN12595
CERTIFICATIONS :
#009768
Mayra Sanchez
5845 W Flagler St
Miami, FL 33144
(305) 261-8025
Special Needs: Yes
English, Spanish
T 9am - 5pm
W 9am-5pm, Th 12am-5pm,F
9am-5pm
S 9am - 12pm
# DN9618 Sanchez, Mayra*
NPI: 1558680439 LIC: DN9618
CERTIFICATIONS :
#018131
Med Dental Associates
7200 Nw 7Th St. #333
Miami, FL 33126
(305) 264-0063
Special Needs: No
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN20905 Rodriguez Castro, Miriam
NPI: 1992051700 LIC: DN20905
CERTIFICATIONS :
# DN17094 Rodriguez, Roxana
NPI: 1336263912 LIC: DN17094
CERTIFICATIONS :
#FQHC012099
Miami Beach Community Health
Center, Inc.
710 Alton Rd
Miami Beach, FL 33139
(305) 538-8835
Special Needs: Yes
English, Spanish
M 7am - 6pm, T 7am - 5pm
Th-F 7am-5pm
# DN15270 Amundaray, Juan
NPI: 1306218797 LIC: DN15270
CERTIFICATIONS :
# DN23894 Kinsey, Josefina
NPI: 1043620990 LIC: DN23894
CERTIFICATIONS :
# DN15859 Rodriguez, Hernan
NPI: 1003950502 LIC: DN15859
CERTIFICATIONS :
# DN23703 Tellez Armenteros, Ana
NPI: 1356828008 LIC: DN23703
CERTIFICATIONS :
#FQHC015504
Miami Beach Community Health
Center, Inc.
11645 Biscayne Blvd. Ste 401-403
North Miami, FL 33181
(305) 538-8835
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 7am-4pm
W-F 7am-4pm
# DN15270 Amundaray, Juan
NPI: 1306218797 LIC: DN15270
CERTIFICATIONS :
# DN23894 Kinsey, Josefina
NPI: 1043620990 LIC: DN23894
CERTIFICATIONS :
# DN15859 Rodriguez, Hernan
NPI: 1003950502 LIC: DN15859
CERTIFICATIONS :
# DN23703 Tellez Armenteros, Ana
NPI: 1356828008 LIC: DN23703
CERTIFICATIONS :
#006579
Miami International Mall Dental
1455 Nw 107Th Ave, Ste 584
Doral, FL 33172
(305) 597-8787
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S 9am - 9pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN14223 Gerry, Charlotte
NPI: 1770789455 LIC: DN14223
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 47 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#CHC022739
Miami Lakes Cosmetic Dentistry
6600 Cow Pen Road
Hialeah, FL 33014
(305) 823-7521
Special Needs: Yes
English
M-T 9am-6pm
W 12pm-7pm, Th 9am-6pm,F
9am-2pm
# DN20996 Peralta, Johnny
NPI: 1396179701 LIC: DN20996
CERTIFICATIONS :
#011787
Miami Smile Studio Corporation
427 Hialeah Dr
Hialeah, FL 33010
(786) 391-4566
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN17980 Eng, Martha
NPI: 1730345091 LIC: DN17980
CERTIFICATIONS :
# DN18258 Hossain, Marta
NPI: 1699912865 LIC: DN18258
CERTIFICATIONS :
#021944
Migdalia I Seijas DDS, PA
1169 W. 35Th Street
Hialeah, FL 33012
(305) 819-0820
Special Needs: Yes
English, Spanish
M 11am - 6pm, T 10am - 6pm
W-Th 11am-6pm
# DN13282 Seijas, Migdalia
NPI: 1548677271 LIC: DN13282
CERTIFICATIONS :
#011422
Miro Kendall Dental Office
13550 Sw 88 St, Ste 100
Miami, FL 33186
(305) 273-4334
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN11650 Miro, Claudio
NPI: 1417024118 LIC: DN11650
CERTIFICATIONS :
• Conscious Sedation
# DN16786 Miro, Kiara
NPI: 1427078625 LIC: DN16786
CERTIFICATIONS :
# DN16862 Trujillo, Alexander
NPI: 1043231996 LIC: DN16862
CERTIFICATIONS :
• Conscious Sedation
#012860
MJ Dental Office
2360 W. 68Th St Ste 124
Hialeah, FL 33016
(305) 825-7447
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN21842 Alvarado, Yailen
NPI: 1700235363 LIC: DN21842
CERTIFICATIONS :
# D22548 Dopazo, Dhunia
NPI: 1467982629 LIC: D22548
CERTIFICATIONS :
# DN19789 Gil Araujo, Eduardo
NPI: 1841553112 LIC: DN19789
CERTIFICATIONS :
#016236
Morell Dental Care
3750 W. 16 Ave Ste 236-U
Hialeah, FL 33012
www.morelldental.com
(305) 231-0545
Special Needs: Yes
English, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN17626 Morell, Nayade
NPI: 1942396502 LIC: DN17626
CERTIFICATIONS :
#013978
My Smile Center
12800 Sw 8Th St
Miami, FL 33184
(786) 332-3176
Special Needs: Yes
English, Spanish
M 10am - 6pm,
W 9am-6pm, Th 10am-6pm,F
9am-4pm
S 9am - 3pm
# DN13222 Friedman, Rene
NPI: 1689890436 LIC: DN13222
CERTIFICATIONS :
#017854
Naranja Family Dentistry PA
27325 S. Dixie Hwy
Homestead, FL 33032
(786) 601-2644
Special Needs: No
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 2pm
# DN19240 Lea Plaza, Rodolfo
NPI: 1932407103 LIC: DN19240
CERTIFICATIONS :
#FQHC7695
Naranja Health Center
13805 Sw 264Th Street
Homestead, FL 33032
www.chisouthfl.org
(305) 258-8066
Special Needs: Yes
English, Chinese Mandarin, Creoles
and Pidgins English-based(other),
French, Polish, Spanish
Th-F 8am-6pm
S 8am - 12pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 48 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#011548
New Dental Care Corp
1251 Nw 36 Street Ste A
Miami, FL 33142
(305) 649-9443
Special Needs: Yes
English, Spanish
M 8am - 5pm, T 9am - 6pm
W 9am-6pm, Th 8am-5pm,F 9am-4pm
# DN11884 Soler, Rosa
NPI: 1083738652 LIC: DN11884
CERTIFICATIONS :
# DN23694 Yglesias Ruiz, Erick
NPI: 1427534239 LIC: DN23694
CERTIFICATIONS :
• Inhalation Sedation
#013438
New Family Dentistry
1410 W. 68Th St
Hialeah, FL 33014
(305) 557-6968
Special Needs: Yes
English, Spanish
M-T 9am-8pm
W-Th 9am-8pm
# DN12604 Mendigutia, Jose
NPI: 1396876991 LIC: DN12604
CERTIFICATIONS :
#009811
Norberto J. Hernandez D.D.S.,
P.A.
1235 Sw 27Th Ave
Miami, FL 33135
(305) 642-7796
Special Needs: Yes
English, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN14451 Hernandez, Norberto
NPI: 1285693267 LIC: DN14451
CERTIFICATIONS :
#010340
NSU- College of Dental Medicine -
NMB
1750 Ne 167Th St
North Miami Beach, FL 33162
(954) 262-1660
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DTP546 Bezerra, Anthony
NPI: 1972800852 LIC: DTP546
CERTIFICATIONS :
# DTP593 Block, Robert
NPI: 1245362516 LIC: DTP593
CERTIFICATIONS :
# DN13419 Ede-Nichols, Diane
NPI: 1225145683 LIC: DN13419
CERTIFICATIONS :
# DN22197 Khatib, Adel
NPI: 1235582503 LIC: DN22197
CERTIFICATIONS :
# DN23890 Robinson, Christina
NPI: 1386023810 LIC: DN23890
CERTIFICATIONS :
#014842
Oceandents Inc.
8216 W Flagler St
Miami, FL 33144
(786) 615-8586
Special Needs: No
English, Spanish
T 10am - 6pm
W-F 10am-6pm
# DN20900 Fernandez Dominguez,
Giselle
NPI: 1235484890 LIC: DN20900
CERTIFICATIONS :
#013413
Omar Perez-Murguia, DDS, PA
9835 Sw 40Th Street
Miami, FL 33165
(305) 552-6446
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN15727 Perez-Murguia, Omar
NPI: 1033210216 LIC: DN15727
CERTIFICATIONS :
#021740
Ortholine Family Dentistry
3934 Sw 8Th Street, Ste 305
Coral Gables, FL 33134
(305) 967-8882
Special Needs: No
English, Spanish
M 10am - 5pm,
W 10am-5pm,
# DN12529 Martinez, Jose
NPI: 1780798926 LIC: DN12529
CERTIFICATIONS :
#019161
Palmetto Dental Studio, Inc.
7306 W 20 Ave
Hialeah, FL 33016
www.thepalmettodentalstudio.com
(786) 747-4763
Special Needs: Yes
English, Spanish
M 8am - 5pm, T 8am - 7pm
W 8am-5pm, Th 8am-7pm,F 8am-5pm
S 9am - 3pm
# DN22568 Benavides, Alina
NPI: 1629507470 LIC: DN22568
CERTIFICATIONS :
#014229
Pan American Dental P.A. &
Assoc.
2060 Sw 27Th Ave
Miami, FL 33145
(305) 444-4430
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 1pm
# DN20998 Gutierrez, Marlen
NPI: 1740686948 LIC: DN20998
CERTIFICATIONS :
#014230
Pan American Dental P.A. &
Assoc.
1124 W. 29Th St
Hialeah, FL 33012
(305) 885-7767
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN20998 Gutierrez, Marlen
NPI: 1740686948 LIC: DN20998
CERTIFICATIONS :
#018945
Paya Dental and Associates
2143 Nw 7Th Street
Miami, FL 33125
(305) 541-5103
Special Needs: Yes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 49 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 3pm
# DN22785 Rielo, Miguel
NPI: 1376079939 LIC: DN22785
CERTIFICATIONS :
#008306
Pedro Alvarez DDS and Associates,
PA
610 E. 4Th Ave
Hialeah, FL 33010
(305) 885-5026
Special Needs: Yes
English, Spanish
M-T 1pm-6pm
W-Th 1pm-6pm
# DN11762 Alvarez, Pedro
NPI: 1235271255 LIC: DN11762
CERTIFICATIONS :
#018202
Pedro Quesada DDS PA
742 W. 49Th St
Hialeah, FL 33012
(786) 534-9216
Special Needs: Yes
English, Spanish
M 9am - 6pm, T 11am - 7pm
W 9am-6pm, Th 11am-7pm,F
9am-6pm
# DN21528 Quezada, Pedro
NPI: 1164898177 LIC: DN21528
CERTIFICATIONS :
#021744
Perez Dental Group Inc
7801 Coral Way, Ste 122
Miami, FL 33155
(786) 360-3694
Special Needs: Yes
English, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN21498 Perez Carmona, Alba
NPI: 1548636244 LIC: DN21498
CERTIFICATIONS :
#015911
Perkadent
1878 Sw 57Th Ave
Miami, FL 33155
(305) 262-9299
Special Needs: Yes
English, Spanish
M 8am - 3pm, T 9am - 5pm
W-F 9am-5pm
S 8am - 2pm
# DN20428 Revoredo, Karim
NPI: 1366730384 LIC: DN20428
CERTIFICATIONS :
#018714
Pro Dental Center West Hialeah
400 West 65 Street
Hialeah, FL 33012
(305) 827-0434
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN17100 Corrales-Iglesias, Luisa
NPI: 1861546277 LIC: DN17100
CERTIFICATIONS :
#008238
Professional Dental Group, PA
10122 West Flagler Street
Miami, FL 33174
(305) 226-3386
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN14823 Baro, Rosemarie
NPI: 1396758165 LIC: DN14823
CERTIFICATIONS :
#008232
Professional Dental Solutions
7900 Nw 27Th Ave, Ste 275
Miami, FL 33147
(305) 693-7988
Special Needs: Yes
English, Spanish
M-T 9am-4pm
W-F 9am-4pm
# DN16699 Diaz, Gertrudis*
NPI: 1932248044 LIC: DN16699
CERTIFICATIONS :
# DN17350 Ramos, Luis*
NPI: 1114000304 LIC: DN17350
CERTIFICATIONS :
#017415
Quality Professional Dentistry
Corp
5040 Nw 7Th St Ste 632
Miami, FL 33126
www.qualitydentatist Miami.com
(305) 342-2020
Special Needs: No
English, Spanish
M-T 10am-6pm
W-F 10am-6pm
S 10am - 5pm
# DN11609 Herdocia, Filiberto
NPI: 1750788030 LIC: DN11609
CERTIFICATIONS :
#009717
Ramos Dental Associates
4564 West 12Th Ave
Hialeah, FL 33012
(305) 558-2446
Special Needs: Yes
English, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN17350 Ramos, Luis
NPI: 1114000304 LIC: DN17350
CERTIFICATIONS :
#017261
Renata Kleiner-Pastoriza DDS PA
9654 Sw 72 St
Miami, FL 33173
(305) 598-3704
Special Needs: Yes
English, Spanish, Polish
M 10am - 6pm, T 9am - 6pm
W 9am-6pm, Th 9am-5pm,F 9am-2pm
# DN10551 Kleiner, Renata
NPI: 1700902400 LIC: DN10551
CERTIFICATIONS :
• Inhalation Sedation
#016138
Right Care Dental
8290 Bird Road, Ste 100
Miami, FL 33155
(786) 206-6021
Special Needs: Yes
English, Spanish
T 9am - 6pm
Th-F 9am-6pm
S 9am - 2pm
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
#022434
Right Care Dental LLC
1490 W. 49Th Place, Ste 220
Hialeah, FL 33012
www.rightcaredental.com
(305) 456-1927
Special Needs: Yes
Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 2pm
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
#008233
Rolando J. Molina, DDS, PA
45 Nw 8Th Street, Sutie #101
Homestead, FL 33030
(305) 242-5223
Special Needs: No
English, Spanish
T 11am - 7pm
Th-F 11am-7pm
# DN14344 Molina, Rolando*
NPI: 1689700221 LIC: DN14344
CERTIFICATIONS :
#008234
Rolando J. Molina, DDS, PA
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 50 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
5991 Sw 8Th Street
Miami, FL 33144
(305) 262-0505
Special Needs: Yes
English, Spanish
M 11am - 7pm,
W 11am-7pm,
# DN14344 Molina, Rolando*
NPI: 1689700221 LIC: DN14344
CERTIFICATIONS :
#007730
Rosario Molina, DMD
4835 East 4Th Ave, Ste # A
Hialeah, FL 33013
(305) 685-5133
Special Needs: Yes
English, Spanish
W 9am-6pm,
# DN9515 Molina, Rosario
NPI: 1912231549 LIC: DN9515
CERTIFICATIONS :
#008237
Rosemarie Baro, DDS
1449 West Flagler Street
Miami, FL 33135
(305) 649-3500
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN14823 Baro, Rosemarie
NPI: 1396758165 LIC: DN14823
CERTIFICATIONS :
#022337
Ruiz Family Dentistry
10550 Nw 77 Court, Ste 220
Hialeah, FL 33016
(786) 401-7566
Special Needs: Yes
English, Spanish
M 10am - 7pm, T 11am - 7pm
W-Th 10am-7pm
S 10am - 2pm
# DN22962 Ruiz Rodriguez, Julian
NPI: 1447619820 LIC: DN22962
CERTIFICATIONS :
#011966
Salazar Dental
8346 Sw 8 St
Miami, FL 33144
(305) 269-0208
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN18913 Salazar, Manuel
NPI: 1699097261 LIC: DN18913
CERTIFICATIONS :
#012093
Salvador Rosales DDS P.A.
8150 Sw 8Th St Ste 206
Miami, FL 33144
(305) 261-5556
Special Needs: No
English, Spanish
M-T 9am-6pm
Th-F 9am-6pm
# DN12058 Rosales, Salvador
NPI: 1457441511 LIC: DN12058
CERTIFICATIONS :
#009227
Sandy Dental, Inc
8000 W. Flagler St. Ste 204
Miami, FL 33144
www.sanderdental.net
(305) 266-5222
Special Needs: No
Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN15375 Borges, Jorge
NPI: 1144361916 LIC: DN15375
CERTIFICATIONS :
• Inhalation Sedation
#014843
Simple Smiles LLC
18400 Nw 75Th Place, Ste 121
Miami, FL 33015
(305) 381-5412
Special Needs: Yes
English, Spanish
M 9am - 7pm, T 9am - 5pm
Th-F 9am-5pm
S 9am - 12pm
# DN17310 Lleo, Pedro
NPI: 1942306394 LIC: DN17310
CERTIFICATIONS :
#013979
Smile Design
2915 Nw 7Th St
Miami, FL 33125
(305) 846-9082
Special Needs: Yes
English, Spanish
M 8am - 4pm, T 11am - 7pm
Th-F 8am-4pm
# DN19487 Perez, Diley
NPI: 1780962092 LIC: DN19487
CERTIFICATIONS :
#006611
Smile Perfect Dental Health
Center
580 E. 49Th Street
Hialeah, FL 33013
www.easthialehdental.com
(305) 557-6711
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN13355 Cardenas, Elio
NPI: 1134287659 LIC: DN13355
CERTIFICATIONS :
#016312
Smile Perfect Dental Health
Center II
1075 E. 4Th Ave
Hialeah, FL 33010
(305) 557-6712
Special Needs: Yes
English, Spanish
M-T 9am-7pm
W-F 9am-7pm
# DN13355 Cardenas, Elio
NPI: 1134287659 LIC: DN13355
CERTIFICATIONS :
#FQHC7693
South Dade Health Center
13600 Sw 312Th Street
Homestead, FL 33033
(305) 242-6069
Special Needs: Yes
English, Chinese Mandarin, Creoles
and Pidgins English-based(other),
French, Polish, Spanish
T 8am - 6pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#021604
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 51 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
South Dental at Forest
Lakes-Kendall Square Inc
16705 Sw 95Th Street
Miami, FL 33196
www.southdental.org
(786) 329-5909
Special Needs: No
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 8am - 3pm
# DN14672 Tobon-Angel, Elias
NPI: 1689794885 LIC: DN14672
CERTIFICATIONS :
#019580
South Dixie Dental LLC
12531 South Dixie Hwy
Miami, FL 33156
(786) 842-3132
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN13836 Gonzalez, Maria
NPI: 1518244862 LIC: DN13836
CERTIFICATIONS :
#023126
South Florida Dental Care
922 East 25Th Street
Hialeah, FL 33013
(786) 542-9700
Special Needs: No
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN19530 Swanson, Wendy
NPI: 1790085819 LIC: DN19530
CERTIFICATIONS :
#009753
Southland Mall Dental
20505 S. Dixie Hwy Ste 1683
Miami, FL 33189
(305) 232-3737
Special Needs: Yes
English, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#016689
Stomatcare
15516 Sw 88Th Street
Miami, FL 33196
(305) 330-6359
Special Needs: Yes
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN22695 Toribio Fabelo, Leydy
NPI: 1033639554 LIC: DN22695
CERTIFICATIONS :
• Inhalation Sedation
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 52 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
#016775
Stomatcare
1602 Ne 163Rd St.
North Miami Beach, FL 33162
(305) 330-6382
Special Needs: Yes
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN22695 Toribio Fabelo, Leydy
NPI: 1033639554 LIC: DN22695
CERTIFICATIONS :
• Inhalation Sedation
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
#016776
Stomatcare
522 E. 25Th St
Hialeah, FL 33013
(305) 330-6351
Special Needs: Yes
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN22695 Toribio Fabelo, Leydy
NPI: 1033639554 LIC: DN22695
CERTIFICATIONS :
• Inhalation Sedation
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
#018551
Stomatcare
10457 Sw 40Th St
Miami, FL 33165
(305) 602-1638
Special Needs: Yes
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
#022892
Sunny Dental Care
9766 Sw 24Th Street, Ste 8
Miami, FL 33165
(305) 995-0542
Special Needs: No
English, Spanish
T 9am - 5pm
S 9am - 1pm
# DN21542 Herrera Casas, Sunilda
NPI: 1447673629 LIC: DN21542
CERTIFICATIONS :
#023021
Sunset Center Dental Service
10300 Sw 72 Sunset Drive, Ste 280
Miami, FL 33173
(786) 534-7314
Special Needs: No
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 12pm
# DN19530 Swanson, Wendy
NPI: 1790085819 LIC: DN19530
CERTIFICATIONS :
#007978
Sunshine Dental Center
4800 Nw 7Th Ave
Miami, FL 33127
(305) 756-3393
Special Needs: Yes
Spanish
M 10am - 2pm, T 11am - 6pm
W 10am-5pm, Th 10am-3pm,F
11am-5pm
# DN12108 Menendez, Alexander
NPI: 1467722546 LIC: DN12108
CERTIFICATIONS :
#018201
Superior Dental
148 Hialeah Drive
Hialeah, FL 33010
www.superiordentaldds.com
(786) 360-6262
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 1pm
# DN12018 Marini, Nohelia
NPI: 1568640852 LIC: DN12018
CERTIFICATIONS :
#008295
Susana Lizaso, DDS
4999 West 8Th Ave, Ste 28
Hialeah, FL 33012
(305) 556-6055
Special Needs: Yes
English, Spanish
M 9am - 5pm, T 10am - 6pm
W-Th 9am-5pm
# DN14242 Lizaso, Susana
NPI: 1174602429 LIC: DN14242
CERTIFICATIONS :
#022225
Sweet Smile Dental
16010 Nw 57Th Ave, Ste 130
Miami Lakes, FL 33014
(786) 536-9411
Special Needs: No
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN17960 Gonzalez, Susana
NPI: 1457654824 LIC: DN17960
CERTIFICATIONS :
#013762
Sylvia Santana P.A.
11300 Nw 87Th Ct # 166
Hialeah, FL 33018
www.biltmoredental.com
(305) 364-9322
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN19864 Santana-Mentrasti, Sylvia
NPI: 1679820344 LIC: DN19864
CERTIFICATIONS :
#008296
The Family Dental Care Center
646 W Palm Dr, Ste 200
Florida City, FL 33034
(305) 242-1200
Special Needs: No
English
M-T 9am-5pm
W-Th 9am-5pm
# DN14560 De la Cruz, Alejandro
NPI: 1013152016 LIC: DN14560
CERTIFICATIONS :
# DN13073 Gonzalez Sr., Carlos
NPI: 1790959963 LIC: DN13073
CERTIFICATIONS :
#021453
The Tooth Place
8 Palms Plz
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 53 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Homestead, FL 33030
(305) 245-7974
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 4pm
# DN13216 Alvarado, Adolfo
NPI: 1881782993 LIC: DN13216
CERTIFICATIONS :
#011963
Thomas Dental Associates
14050 Nw 7Th Ave
Miami, FL 33168
(305) 688-7989
Special Needs: Yes
Spanish, English, Creoles and Pidgins
English-based(other), Haitian; Haitian
Creole
M-T 12pm-6pm
W-Th 12pm-6pm
# DN9652 Krakauer, Thomas
NPI: 1093841009 LIC: DN9652
CERTIFICATIONS :
#008256
Tin Wai Hui
16209 Ne 13Th Ave
North Miami Beach, FL 33162
(305) 940-9888
Special Needs: Yes
English, Spanish, Mandarin
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN15966 Elperin, Alexei
NPI: 1295930063 LIC: DN15966
CERTIFICATIONS :
# DN18608 Haratz, Zina
NPI: 1972747608 LIC: DN18608
CERTIFICATIONS :
# DN12723 Hui, Tin
NPI: 1952408619 LIC: DN12723
CERTIFICATIONS :
# DN20869 Kiani, Kamran
NPI: 1699175729 LIC: DN20869
CERTIFICATIONS :
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
#008258
Tin Wai Hui, DMD, PA
12651 S. Dixie Hwy, #400
Miami, FL 33156
(305) 595-4548
Special Needs: Yes
English, Spanish, Cantonese, French,
Mandarin
M 9am - 5pm, T 10am - 6pm
Th-F 10am-6pm
S 9am - 2pm
# DN15384 Cheng, Xiaofang
NPI: 1104945807 LIC: DN15384
CERTIFICATIONS :
# DN12723 Hui, Tin
NPI: 1952408619 LIC: DN12723
CERTIFICATIONS :
# DN20869 Kiani, Kamran
NPI: 1699175729 LIC: DN20869
CERTIFICATIONS :
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
#018214
Traviesas Dental Care
4301 Palm Ave, Ste F
Hialeah, FL 33012
(305) 826-8980
Special Needs: No
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN22857 Traviesas Herrera, Eladio
NPI: 1992187876 LIC: DN22857
CERTIFICATIONS :
#021734
Traviesas Dental Care
7933 Nw 2Nd Street
Miami, FL 33126
(305) 261-5251
Special Needs: Yes
English, Spanish
M 9am - 6pm,
W-Th 9am-6pm
S 8am - 2pm
# DN22857 Traviesas Herrera, Eladio
NPI: 1992187876 LIC: DN22857
CERTIFICATIONS :
#007535
Unlimited Dental Care
11498 Quail Roost Drive
Miami, FL 33157
(305) 232-4469
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W 9am-6pm, Th 9am-5pm,F 9am-4pm
S 8am - 2pm
# DN18983 Batista, Virginia
NPI: 1760702575 LIC: DN18983
CERTIFICATIONS :
# DN18627 Perez, Alina
NPI: 1649408469 LIC: DN18627
CERTIFICATIONS :
# DN16616 Villar, Tania
NPI: 1245320068 LIC: DN16616
CERTIFICATIONS :
#019072
Vassallo Dental Office P.A
8782 Sw 8Th St. Ste A
Miami, FL 33174
(305) 552-5340
Special Needs: N/A
English, Spanish
M-T 10am-6pm
W-Th 10am-6pm
# DN11722 Vasallo, Francisco
NPI: 1730207077 LIC: DN11722
CERTIFICATIONS :
#011679
Verrett Dental Center
3058 Nw 79 St
Miami, FL 33147
(305) 696-9999
Special Needs: Yes
English, Spanish
T 10am - 4pm
W-Th 10am-4pm
# DN18479 Hasan-Verrett, Hajar
NPI: 1386894715 LIC: DN18479
CERTIFICATIONS :
#FQHC7696
West Perrine Health Center
18255 Homestead Ave
Miami, FL 33157
(305) 234-7676
Special Needs: Yes
English, Chinese Mandarin, Creoles
and Pidgins English-based(other),
French, Polish, Spanish
M 10am - 7pm, T 8am - 5pm
Th-F 8am-5pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 54 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#006580
Westland Mall Dental
1665 W. 49Th St, Ste 1484
Hialeah, FL 33012
(305) 828-7779
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#009582
World Dental Care
1370 East 4 Ave
Hialeah, FL 33010
(305) 888-1458
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN22851 Garcia, Lisset
NPI: 1487036216 LIC: DN22851
CERTIFICATIONS :
# DN11884 Soler, Rosa
NPI: 1083738652 LIC: DN11884
CERTIFICATIONS :
#016311
Yudisbel Molina Ariza
8500 W Flagler St Ste 104A
Miami, FL 33144
www.yudisbelmolinadmd.com
(305) 226-0803
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN21386 Molina Ariza, Yudisbel
NPI: 1760865067 LIC: DN21386
CERTIFICATIONS :
#008225
Zoraida T. Sanchez
1619 North East 8 Street
Homestead, FL 33030
(305) 247-9292
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN16063 Sanchez, Zoradia
NPI: 1093824096 LIC: DN16063
CERTIFICATIONS :
#012554
Zuzel Trujillo, DMD, PA
13323 Sw 42Nd St
Miami, FL 33175
(305) 223-2828
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN18673 Trujillo, Zuzel
NPI: 1285860353 LIC: DN18673
CERTIFICATIONS :
ENDODONTICS
#CHC8227
Borinquen Health Care Center,
INC
3601 Federal Hwy, 5Th Floor
Miami, FL 33137
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 55 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(305) 576-6611
Special Needs: Yes
English, Spanish, Creoles and Pidgins
Portuguese-based(other), French,
Persian (T), Portuguese
M-T 8am-5pm
W 8am-5pm, Th 8am-6pm,F 8am-4pm
S 8am - 2pm
# DN19839 Gutierrez, Carlos
NPI: 1861756603 LIC: DN19839
CERTIFICATIONS :
• Inhalation Sedation
#FQHC017137
Borinquen Health Care Center,
Inc.
708 Ne 125Th St
North Miami, FL 33161
(305) 576-6611
Special Needs: Yes
English, Farsi, French, Spanish
M-T 8am-5pm
W-Th 8am-5pm
S 8am - 2pm
# DN19839 Gutierrez, Carlos
NPI: 1861756603 LIC: DN19839
CERTIFICATIONS :
• Inhalation Sedation
#009814
Bravo Dental P.A.
909 N. Miami Beach Blvd, Ste 501
North Miami Beach, FL 33162
(305) 945-9333
Special Needs: Yes
English, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN19497 Yanez Bravo, Maria
NPI: 1891074183 LIC: DN19497
CERTIFICATIONS :
• Inhalation Sedation
#022853
Dental Group of South Florida
13419 Sw 56Th Street
Miami, FL 33175
(305) 556-2663
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN17638 Alvarez, Maria
NPI: 1124165303 LIC: DN17638
CERTIFICATIONS :
#008978
Dental Group of South Florida II,
Inc
11336 Sw 184Th St
Miami, FL 33157
(305) 251-4262
Special Needs: Yes
English, Spanish
M-T 9am-7pm
W 9am-7pm, Th 9am-7am,F 9am-6pm
# DN17638 Alvarez, Maria
NPI: 1124165303 LIC: DN17638
CERTIFICATIONS :
#009361
Dental Group of South Florida III
101 Westward Dr. Ste A
Miami Springs, FL 33166
(305) 885-1357
Special Needs: No
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN17638 Alvarez, Maria
NPI: 1124165303 LIC: DN17638
CERTIFICATIONS :
#016140
Dental Group of South Florida IV
Inc
11373 Sw 211Th Street, Ste 10
Miami, FL 33189
www.dentalffl.com
(786) 250-5088
Special Needs: Yes
English, Spanish
M-T 10am-7pm
W-F 10am-7pm
# DN17638 Alvarez, Maria
NPI: 1124165303 LIC: DN17638
CERTIFICATIONS :
# DN17433 Martinez, Milton
NPI: 1346326972 LIC: DN17433
CERTIFICATIONS :
#022882
Dental Group of South Florida V
16830 Sw 88Th Street
Miami, FL 33196
(305) 388-4886
Special Needs: No
English, Spanish
M-T 9am-6pm
Th-F 9am-6pm
# DN17638 Alvarez, Maria
NPI: 1124165303 LIC: DN17638
CERTIFICATIONS :
#007974
Dr. Alfredo Santeiro, DDS
2555 Collins Ave, Ste C3
Miami Beach, FL 33140
www.clubatlantisdental.com
(305) 672-9698
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN12959 Santeiro, Alfredo
NPI: 1669602629 LIC: DN12959
CERTIFICATIONS :
#011567
Estetica Dental Gables Inc
4411 West Flagler Street
Miami, FL 33134
(305) 445-5515
Special Needs: Yes
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN19582 Valdes, Marilyn
NPI: 1104103910 LIC: DN19582
CERTIFICATIONS :
#022417
Family Dental Care
3934 Sw 8Th Street, Ste 208
Coral Gables, FL 33134
(305) 392-1958
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21526 Alvarez, Ariam
NPI: 1962841783 LIC: DN21526
CERTIFICATIONS :
#022744
Great Dental Expressions Inc
568 Hialeah Drive
Hialeah, FL 33010
(305) 835-0123
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 5pm
# DN17433 Martinez, Milton
NPI: 1346326972 LIC: DN17433
CERTIFICATIONS :
#013364
Hammocks Dental Center, PA
9280 Hammock Blvd, Ste #102
Miami, FL 33196
(305) 387-5700
Special Needs: Yes
Spanish
M 12pm - 6pm, T 9am - 3pm
W 2pm-6pm, Th 12pm-6pm
S 10am - 1pm
# DN21526 Alvarez, Ariam
NPI: 1962841783 LIC: DN21526
CERTIFICATIONS :
#FQHC018872
Jessie Trice Community Health
Center, Inc
217 Nw 15Th Street
Miami, FL 33136
(305) 637-6400
Special Needs: Yes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 56 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Creoles and Pidgins
English-based(other), English,
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN14544 Cerrud, Clinio
NPI: 1629184676 LIC: DN14544
CERTIFICATIONS :
• Inhalation Sedation
#FQHC015997
Jessie Trice Community Health
Center, Inc.
901 E. 10Th Ave, Bay #39
Hialeah, FL 33010
(305) 637-6400
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M 10am - 6pm,
# DN14544 Cerrud, Clinio
NPI: 1629184676 LIC: DN14544
CERTIFICATIONS :
• Inhalation Sedation
#FQHC016404
Jessie Trice Community Health
Center, Inc.
490 Opa-Locka Blvd
Opa Locka, FL 33054
(305) 637-6400
Special Needs: Yes
English
M-T 8am-5pm
W 8am-5pm, Th 8am-6pm,F 8am-5pm
# DN14544 Cerrud, Clinio
NPI: 1629184676 LIC: DN14544
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9796
Jessie Trice Community Health
Center, Inc.
5361 N.W. 22Nd Ave
Miami, FL 33142
(305) 637-6400
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 8am-5pm
W-F 8am-5pm
# DN14544 Cerrud, Clinio
NPI: 1629184676 LIC: DN14544
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9797
Jessie Trice Community Health
Center, Inc.
5607 Nw 27Th Ave, Ste 2
Miami, FL 33142
(305) 637-6400
Special Needs: No
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 7am-6pm
W-F 7am-6pm
# DN14544 Cerrud, Clinio
NPI: 1629184676 LIC: DN14544
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9799
Jessie Trice Community Health
Center, Inc.
18360 N.W. 7Th Ave
Miami, FL 33169
(305) 637-6400
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 8am-5pm
W-F 8am-5pm
S 9am - 2pm
# DN14544 Cerrud, Clinio
NPI: 1629184676 LIC: DN14544
CERTIFICATIONS :
• Inhalation Sedation
#018466
Maira Morales DDS LLC
5232 W. Flagler St
Miami, FL 33134
(305) 442-0331
Special Needs: No
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21552 Morales, Maira
NPI: 1023202496 LIC: DN21552
CERTIFICATIONS :
#006579
Miami International Mall Dental
1455 Nw 107Th Ave, Ste 584
Doral, FL 33172
(305) 597-8787
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S 9am - 9pm
# DN13421 Gittess, Robert
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
#013978
My Smile Center
12800 Sw 8Th St
Miami, FL 33184
(786) 332-3176
Special Needs: Yes
English, Spanish
M 10am - 6pm,
W 9am-6pm, Th 10am-6pm,F
9am-4pm
S 9am - 3pm
# DN21526 Alvarez, Ariam
NPI: 1962841783 LIC: DN21526
CERTIFICATIONS :
#010340
NSU- College of Dental Medicine -
NMB
1750 Ne 167Th St
North Miami Beach, FL 33162
(954) 262-1660
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN9429 Flax, Michael
NPI: 1164583985 LIC: DN9429
CERTIFICATIONS :
# DN18606 Manjarres, Vivian
NPI: 1073747333 LIC: DN18606
CERTIFICATIONS :
# DN17496 Seltzer, Robert
NPI: 1619082120 LIC: DN17496
CERTIFICATIONS :
# DN14230 Zeim, Jason
NPI: 1760498422 LIC: DN14230
CERTIFICATIONS :
#015408
Paya Dental
2851 W. 68Th St. Bay 12
Hialeah, FL 33018
payadental.com
(786) 502-4467
Special Needs: Yes
English, Spanish
M 9am - 5pm, T 8am - 6pm
W 9am-5pm, Th 8am-6pm,F 9am-5pm
S 9am - 2pm
# DN21221 Paya, Anabel*
NPI: 1609256700 LIC: DN21221
CERTIFICATIONS :
#018945
Paya Dental and Associates
2143 Nw 7Th Street
Miami, FL 33125
(305) 541-5103
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 3pm
# DN21221 Paya, Anabel
NPI: 1609256700 LIC: DN21221
CERTIFICATIONS :
#009753
Southland Mall Dental
20505 S. Dixie Hwy Ste 1683
Miami, FL 33189
(305) 232-3737
Special Needs: Yes
English, Spanish
M-T 10am-9pm
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 57 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
W-F 10am-9pm
S-Su 10am-6pm
# DN13421 Gittess, Robert
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
#006580
Westland Mall Dental
1665 W. 49Th St, Ste 1484
Hialeah, FL 33012
(305) 828-7779
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN13421 Gittess, Robert
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
ORAL SURGEON
#021756
Ambiance Surgical Arts Center
8501 Sw 124Th Ave, Ste 208
Miami, FL 33183
(786) 377-4344
Special Needs: Yes
English, Spanish
M-T 7am-4pm
W 7am-4pm, Th 9am-6pm,F 7am-4pm
# DN21773 Hines, Jerri
NPI: 1861552770 LIC: DN21773
CERTIFICATIONS :
• General Anesthesia
PERIODONTICS
#006579
Miami International Mall Dental
1455 Nw 107Th Ave, Ste 584
Doral, FL 33172
(305) 597-8787
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S 9am - 9pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
#009753
Southland Mall Dental
20505 S. Dixie Hwy Ste 1683
Miami, FL 33189
(305) 232-3737
Special Needs: Yes
English, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
#006580
Westland Mall Dental
1665 W. 49Th St, Ste 1484
Hialeah, FL 33012
(305) 828-7779
Special Needs: Yes
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
MONROE COUNTY
DENTIST
#FQHC7692
Marathon Health Center
2805 Overseas Highway
Marathon, FL 33050
www.chisouthfl.org
(305) 743-4000
Special Needs: Yes
English, Chinese Mandarin, Creoles
and Pidgins English-based(other),
French, Polish, Spanish
T 8am - 7pm
W 8am-5pm, Th 8am-7pm,F 8am-5pm
S 10am - 2pm
# DN19206 Campbell, Lisa
NPI: 1659594497 LIC: DN19206
CERTIFICATIONS :
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
CERTIFICATIONS :
# DN24501 Jaime Garriga, Yanet
NPI: 1134605843 LIC: DN24501
CERTIFICATIONS :
# DN10538 Johnson, Robert
NPI: 1275600686 LIC: DN10538
CERTIFICATIONS :
# DN11108 Lang, Tomas
NPI: 1386758886 LIC: DN11108
CERTIFICATIONS :
# DN17815 Lopez De Victoria,
Millied
NPI: 1467405423 LIC: DN17815
CERTIFICATIONS :
# DN13131 Miranda, Alejandra
NPI: 1558328823 LIC: DN13131
CERTIFICATIONS :
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
# DN14396 Watson-Hamilton, Sheri
NPI: 1053580639 LIC: DN14396
CERTIFICATIONS :
#FQHC011413
RHN Dental Group - Key West
3706 N. Roosevelt Blvd, Ste E
Key West, FL 33040
(305) 517-6613
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23214 Rodriguez Ramos, Oscar
NPI: 1831406982 LIC: DN23214
CERTIFICATIONS :
ENDODONTICS
# DN10562 Llodra, Clara
NPI: 1205816154 LIC: DN10562
CERTIFICATIONS :
# DN17019 Sander, Michael
NPI: 1558878744 LIC: DN17019
CERTIFICATIONS :
NASSAU COUNTY
DENTIST
#CHC9677
DOH - Nassau County Health
Department
37203 Pecan St
Hilliard, FL 32046
(904) 530-6781
Special Needs: Yes
English, Vietnamese
M-T 8am-5pm
W-Th 8am-5pm
# DN14307 Gupton, Frank
NPI: 1962411876 LIC: DN14307
CERTIFICATIONS :
• Inhalation Sedation
# DN10644 Steen, Phillip
NPI: 1215078506 LIC: DN10644
CERTIFICATIONS :
• Inhalation Sedation
#CHC9678
DOH - Nassau County Health
Department
86207 Felmor Rd
Yulee, FL 32097
(904) 875-6090
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN14307 Gupton, Frank
NPI: 1962411876 LIC: DN14307
CERTIFICATIONS :
• Inhalation Sedation
# DN10644 Steen, Phillip
NPI: 1215078506 LIC: DN10644
CERTIFICATIONS :
• Inhalation Sedation
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 58 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
OKALOOSA COUNTY
DENTIST
#FQHC013738
Crestview Dental Center
800 Hospital Dr.
Crestview, FL 32539
www.northfloridamedicalcenters.org
(850) 423-4603
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN11230 Cherkinsky, Jordan
NPI: 1184637787 LIC: DN11230
CERTIFICATIONS :
# DN24185 Durham, Dominique
NPI: 1053972257 LIC: DN24185
CERTIFICATIONS :
# DN14801 Williams, Keith
NPI: 1629296793 LIC: DN14801
CERTIFICATIONS :
OKEECHOBEE COUNTY
DENTIST
#FQHC020247
Florida Community Health
Centers, Inc.
2015 Us Highway 441
Okeechobee, FL 34972
www.fchcinc.org
(863) 763-1951
Special Needs: Yes
English, Spanish
M 8am - 6pm, T 8am - 5pm
W-Th 8am-5pm
# DN20720 Blackwood, Alberto
NPI: 1487057303 LIC: DN20720
CERTIFICATIONS :
# DN13607 Morales, Carlos
NPI: 1457310559 LIC: DN13607
CERTIFICATIONS :
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN23400 Pham, Emily
NPI: 1851947568 LIC: DN23400
CERTIFICATIONS :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
# DN13207 Zayas, Alida
NPI: 1639148968 LIC: DN13207
CERTIFICATIONS :
ORANGE COUNTY
DENTIST
#011595
A.K.M.W. Islam, BDS, P.A.
1925 E. Michigan St Ste 101
Orlando, FL 32806
DRAKISLAM.COM
(407) 896-6336
Special Needs: No
English, Arabic, Bengali, Spanish
M-T 9am-4pm
W-Th 9am-4pm
# DN11823 Islam, A.K.M.W.
NPI: 1225048796 LIC: DN11823
CERTIFICATIONS :
#FQHC7785
Apopka Dental (Community
Health Ctr)
210 E. Seventh Street
Apopka, FL 32703
chcsl.org
(407) 905-8827
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M 8am - 6pm, T 8am - 7pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania*
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#009736
Artistic Smiles of Orlando
3592 Aloma Ave, Ste 1
Winter Park, FL 32792
artisticsmilesoorlando.com
(407) 678-7744
Special Needs: Yes
English, Spanish, Hindi
M-T 8am-5pm
W-Th 8am-5pm
# DN15961 Dhamija, Jugnu
NPI: 1568781227 LIC: DN15961
CERTIFICATIONS :
#010439
Avalon Dental Group
3804 E. Colonial Drive
Orlando, FL 32803
(407) 898-3800
Special Needs: Yes
English, Spanish, Vietnamese
M-T 9am-5pm
W-F 9am-5pm
# DN22748 Chen, Lona*
NPI: 1508387465 LIC: DN22748
CERTIFICATIONS :
# DN17997 Van, Jennie*
NPI: 1831399344 LIC: DN17997
CERTIFICATIONS :
# DN17986 Van, Nga*
NPI: 1023217163 LIC: DN17986
CERTIFICATIONS :
#FQHC9097
Central Florida Family Health
Center, Inc.
5730 Lake Underhill Road
Orlando, FL 32807
mytruehealth.org
(407) 322-8645
Special Needs: Yes
English, Spanish
M-T 8am-6pm
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 59 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
W-Th 8am-6pm
# DN20946 Nguyen, David
NPI: 1811398423 LIC: DN20946
CERTIFICATIONS :
# DN17610 Pinnock, Alyssa
NPI: 1003987157 LIC: DN17610
CERTIFICATIONS :
#FQHC9816
Central Florida Family Health
Center, Inc.
11881 A-E Colonial Drive
Orlando, FL 32826
www.mytruehealth.org
(407) 322-8645
Special Needs: Yes
English, Spanish, Vietnamese
M-T 8am-6pm
W-Th 8am-6pm
# DN20946 Nguyen, David
NPI: 1811398423 LIC: DN20946
CERTIFICATIONS :
# DN17610 Pinnock, Alyssa
NPI: 1003987157 LIC: DN17610
CERTIFICATIONS :
#FQHC7971
Community Health Centers, Inc.
13275 W. Colonial Drive
Winter Garden, FL 34787
(407) 905-8827
Special Needs: Yes
English, Spanish
M 8am - 6pm, T 8am - 7pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania*
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina*
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#007776
Conway Dental Care
3862 Curry Ford Road
Orlando, FL 32806
(407) 894-2048
Special Needs: No
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN10824 Qureshi, Naghman*
NPI: 1558407619 LIC: DN10824
CERTIFICATIONS :
#009737
Daniel Gray Jr., D.D.S., P.A.
1563 E. Silver Star Rd
Ocoee, FL 34761
(407) 291-1056
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 8am-5pm
W-Th 8am-5pm
# DN7499 Gray Jr., Daniel*
NPI: 1669433637 LIC: DN7499
CERTIFICATIONS :
#CHC10238
DOH - Orange County Health
Department
832 West Central Blvd
Orlando, FL 32805
(407) 723-4039
Special Needs: Yes
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN17407 Bello, Andres*
NPI: 1487615019 LIC: DN17407
CERTIFICATIONS :
# DN10829 Russo, Richard*
NPI: 1063553774 LIC: DN10829
CERTIFICATIONS :
#CHC10239
DOH - Orange County Health
Department
5449 S. Semoran Blvd, Ste 19B
Orlando, FL 32822
(407) 723-5264
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17407 Bello, Andres
NPI: 1487615019 LIC: DN17407
CERTIFICATIONS :
# DN10829 Russo, Richard
NPI: 1063553774 LIC: DN10829
CERTIFICATIONS :
#FQHC7786
Eatonville Dental (Community
Health Center)
7900 Forest City Road
Orlando, FL 32810
(407) 905-8827
Special Needs: Yes
English, Spanish
M-T 8am-6pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 60 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#FQHC7970
Lake Ellenor Dental (Community
Health Ctr)
6101 Lake Ellenor Dr. Ste 106
Orlando, FL 32809
www.chcfl.org
(407) 905-8827
Special Needs: No
Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania*
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina*
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#007936
LGB Dental LLC
4638 S. Orange Blossom Trail
Orlando, FL 32839
(407) 251-2223
Special Needs: Yes
English, Spanish, French
T 9am - 5pm
W-F 9am-5pm
# DN16942 Bobadilla, Luz
NPI: 1942321765 LIC: DN16942
CERTIFICATIONS :
#007687
OBT Dental Spa LLC
9753 S. Orange Blossom Trail #105
Orlando, FL 32837
(407) 857-8585
Special Needs: Yes
English, Spanish, Hindi
M-T 8am-4pm
W-F 8am-4pm
# DN19368 Anjum, Sumaya
NPI: 1821385931 LIC: DN19368
CERTIFICATIONS :
# DN17526 Dexter, Stephanie
NPI: 1467507368 LIC: DN17526
CERTIFICATIONS :
# DN16586 Olmos, Rodolfo
NPI: 1679616577 LIC: DN16586
CERTIFICATIONS :
# DN20529 Pinzon, Juan
NPI: 1033537758 LIC: DN20529
CERTIFICATIONS :
# DN21642 Romero- Quevedo,
Margarita
NPI: 1861866782 LIC: DN21642
CERTIFICATIONS :
#FQHC011105
Orange Blossom Family Health
232 North Orange Blossom Trail
Orlando, FL 32805
(407) 428-5751
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 8am-4pm
W-F 8am-4pm
# DN19583 Acosta, Edwin
NPI: 1578729711 LIC: DN19583
CERTIFICATIONS :
# DN19935 Keskar, Meghan
NPI: 1417205790 LIC: DN19935
CERTIFICATIONS :
# DN11833 Lim, Peter
NPI: 1821022526 LIC: DN11833
CERTIFICATIONS :
# DN23622 Pacheco, Magda
NPI: 1699264424 LIC: DN23622
CERTIFICATIONS :
#FQHC021664
Orange Blossom Family Health -
Dental Clinic
3100 Evans Trojan Way
Orlando, FL 32808
(407) 428-5751
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
T 8am - 5pm
# DN19583 Acosta, Edwin*
NPI: 1578729711 LIC: DN19583
CERTIFICATIONS :
# DN19935 Keskar, Meghan*
NPI: 1417205790 LIC: DN19935
CERTIFICATIONS :
# DN23622 Pacheco, Magda*
NPI: 1699264424 LIC: DN23622
CERTIFICATIONS :
#FQHC019163
Orange Blossom Pediatrics
701 W Livingston St Bldg 800
Orlando, FL 32805
(407) 428-5751
Special Needs: Yes
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 61 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish, Chinese (T),
Creoles and Pidgins
English-based(other), Hindi, Tagalog
M-T 8am-5pm
W-F 8am-5pm
# DN19583 Acosta, Edwin*
NPI: 1578729711 LIC: DN19583
CERTIFICATIONS :
# DN19935 Keskar, Meghan*
NPI: 1417205790 LIC: DN19935
CERTIFICATIONS :
# DN11833 Lim, Peter*
NPI: 1821022526 LIC: DN11833
CERTIFICATIONS :
# DN23622 Pacheco, Magda*
NPI: 1699264424 LIC: DN23622
CERTIFICATIONS :
#FQHC7784
Pine Hills Dental (Community
Health Center)
840 Mercy Drive
Orlando, FL 32810
www.chcfh.og
(407) 905-8827
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M 8am - 5pm, T 8am - 6pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN7872 Juliao, Carl
NPI: 1992930770 LIC: DN7872
CERTIFICATIONS :
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN19016 Munguba, Bozena
NPI: 1043530462 LIC: DN19016
CERTIFICATIONS :
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN15582 Nicola, Rania*
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN12387 Poveromo, Marc
NPI: 1780745141 LIC: DN12387
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN13300 Velez-Leon, Waleska
NPI: 1316040819 LIC: DN13300
CERTIFICATIONS :
# DN23384 Vo, Tina*
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#021739
Yes! Dental Associates of Florida
12554 S. John Young Parkway, Ste
104
Orlando, FL 32837
(407) 847-8000
Special Needs: Yes
English, Spanish
M-T 7am-3pm
Th-F 7am-3pm
# DN17219 Colon, Agdha
NPI: 1487614533 LIC: DN17219
CERTIFICATIONS :
# DN16372 Katsur, Justin
NPI: 1275592040 LIC: DN16372
CERTIFICATIONS :
• Inhalation Sedation
ORAL SURGEON
#018735
Central Florida Institute of Oral
Surgery & Dental Implants
320 N. Edinburg Drive Ste A
Winter Park, FL 32792
www.centralfloridaos.com
(407) 951-6554
Special Needs: Yes
English, Spanish
M-T 7am-5pm
W-Th 7am-5pm
# DN19378 Samaniego, Juan
NPI: 1467692129 LIC: DN19378
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN16473 Walcott, Sean
NPI: 1841250743 LIC: DN16473
CERTIFICATIONS :
• General Anesthesia
OSCEOLA COUNTY
DENTIST
#014854
Barinas Dental Associates
2834 E. Osceola Parkway
Kissimmee, FL 34743
(407) 530-5881
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 9am-6pm
# DN12474 Barinas, Norma*
NPI: 1780690123 LIC: DN12474
CERTIFICATIONS :
# DN14806 Barinas-Duval, Froilan*
NPI: 1699748442 LIC: DN14806
CERTIFICATIONS :
• Inhalation Sedation
#022972
Cano Dental
1507 N. John Young Parkway
Kissimmee, FL 34741
(407) 606-8012
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN24069 Rodriguez Gonzalez,
David
NPI: 1548798960 LIC: DN24069
CERTIFICATIONS :
#013248
Fortune Dental
2324 Fortune Road
Kissimmee, FL 34744
(407) 348-2002
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN19368 Anjum, Sumaya*
NPI: 1821385931 LIC: DN19368
CERTIFICATIONS :
# DN17526 Dexter, Stephanie*
NPI: 1467507368 LIC: DN17526
CERTIFICATIONS :
# DN16586 Olmos, Rodolfo*
NPI: 1679616577 LIC: DN16586
CERTIFICATIONS :
# DN20529 Pinzon, Juan*
NPI: 1033537758 LIC: DN20529
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 62 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN20125 Puerto, Sandra*
NPI: 1972941961 LIC: DN20125
CERTIFICATIONS :
# DN21642 Romero- Quevedo,
Margarita*
NPI: 1861866782 LIC: DN21642
CERTIFICATIONS :
#013246
Hallmark Dental
1014 Buenaventura Blvd
Kissimmee, FL 34743
(407) 344-2400
Special Needs: No
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN17526 Dexter, Stephanie
NPI: 1467507368 LIC: DN17526
CERTIFICATIONS :
# DN16586 Olmos, Rodolfo
NPI: 1679616577 LIC: DN16586
CERTIFICATIONS :
# DN20529 Pinzon, Juan
NPI: 1033537758 LIC: DN20529
CERTIFICATIONS :
# DN20125 Puerto, Sandra
NPI: 1972941961 LIC: DN20125
CERTIFICATIONS :
# DN21642 Romero- Quevedo,
Margarita
NPI: 1861866782 LIC: DN21642
CERTIFICATIONS :
#012264
Mid Florida Dental Associates
809 E Oak St Ste 101
Kissimmee, FL 34744
(407) 870-5004
Special Needs: Yes
English, Spanish, Hindi
M-T 8am-4pm
W-F 8am-4pm
# DN10632 Sharma, Rajesh
NPI: 1134212103 LIC: DN10632
CERTIFICATIONS :
#FQHC016506
Osceola Community Centers @
St. Cloud
1050 Grape Ave.
Saint Cloud, FL 34769
(407) 943-8600
Special Needs: Yes
English, Spanish
M 8am - 5pm,
Th-F 8am-5pm
# DN16236 Calcagno, Manuel
NPI: 1194866616 LIC: DN16236
CERTIFICATIONS :
# DN15786 Ferro, David
NPI: 1063451326 LIC: DN15786
CERTIFICATIONS :
# DN14586 Henninger, Rosalba
NPI: 1598842668 LIC: DN14586
CERTIFICATIONS :
# DN20490 Powell, Makom
NPI: 1154745552 LIC: DN20490
CERTIFICATIONS :
#FQHC016507
Osceola Community Health
Centers @ Intercession City
1703 Business Center Lane
Kissimmee, FL 34758
(407) 943-8600
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN16236 Calcagno, Manuel
NPI: 1194866616 LIC: DN16236
CERTIFICATIONS :
# DN15786 Ferro, David
NPI: 1063451326 LIC: DN15786
CERTIFICATIONS :
# DN14586 Henninger, Rosalba
NPI: 1598842668 LIC: DN14586
CERTIFICATIONS :
# DN20490 Powell, Makom
NPI: 1154745552 LIC: DN20490
CERTIFICATIONS :
#FQHC016508
Osceola Community Health
Centers @Poinciana
109 N. Doverplum Ave.
Kissimmee, FL 34758
(407) 943-8600
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN16236 Calcagno, Manuel
NPI: 1194866616 LIC: DN16236
CERTIFICATIONS :
# DN15786 Ferro, David
NPI: 1063451326 LIC: DN15786
CERTIFICATIONS :
# DN14586 Henninger, Rosalba
NPI: 1598842668 LIC: DN14586
CERTIFICATIONS :
# DN20490 Powell, Makom
NPI: 1154745552 LIC: DN20490
CERTIFICATIONS :
#015403
Yes! Dental Associates of Florida
701 E. Oak Street Ste B
Kissimmee, FL 34744
(407) 847-8000
Special Needs: Yes
English, Spanish
M-T 9am-7pm
W 9am-5pm, Th 8am-3pm,F 8am-1pm
# DN17219 Colon, Agdha
NPI: 1487614533 LIC: DN17219
CERTIFICATIONS :
# DN16372 Katsur, Justin
NPI: 1275592040 LIC: DN16372
CERTIFICATIONS :
• Inhalation Sedation
ORAL SURGEON
#011436
Kissimmee Oral Surgery
3172 Bill Beck Blvd
Kissimmee, FL 34744
(407) 483-4939
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN17160 Ason, Raphael
NPI: 1659555001 LIC: DN17160
CERTIFICATIONS :
• General Anesthesia
PALM BEACH COUNTY
DENTIST
#016765
Bella Sonrisa Dental
3729 Lake Worth Rd
Palm Springs, FL 33461
(561) 201-8078
Special Needs: Yes
English, Spanish
M 10am - 5pm,
W 10am-5pm,
S 10am - 1pm
# DN20246 Lago-Sanchez, Idelbis
NPI: 1003248824 LIC: DN20246
CERTIFICATIONS :
#022294
Boynton Beach Mall Dental PA
801 N. Congress Ave, Ste 185D
Boynton Beach, FL 33426
(561) 369-7199
Special Needs: Yes
English, Russian, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23652 Ospina, Luz
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 63 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
#022544
Cagigas Dental Services LLC
2311 10Th Ave N, Ste 14
Lake Worth, FL 33461
(561) 814-2888
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 5pm
# DN15662 Gordon, Robert
NPI: 1578582359 LIC: DN15662
CERTIFICATIONS :
#FQHC016392
CL Brumback Primary Care
Clinics
39200 Hooker Highway, Ste 101
Belle Glade, FL 33430
(561) 370-1300
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15769 Alonso, Zenaida*
NPI: 1275586836 LIC: DN15769
CERTIFICATIONS :
# DN20993 Alwehaib, Arwa*
NPI: 1922498070 LIC: DN20993
CERTIFICATIONS :
# DN19227 Bentsi-Enchill, Flora*
NPI: 1669778353 LIC: DN19227
CERTIFICATIONS :
# DN19634 Cucuras, John*
NPI: 1891876322 LIC: DN19634
CERTIFICATIONS :
# DN17819 Momin, Aysha*
NPI: 1649319690 LIC: DN17819
CERTIFICATIONS :
# DN22922 Oliveira, Paulo*
NPI: 1285157826 LIC: DN22922
CERTIFICATIONS :
# DN8969 Rotella, Robert*
NPI: 1447320544 LIC: DN8969
CERTIFICATIONS :
# DN17452 Seminario, Ada*
NPI: 1104921592 LIC: DN17452
CERTIFICATIONS :
#FQHC016393
CL Brumback Primary Care
Clinics
1150 45Th St
West Palm Beach, FL 33407
(561) 370-1300
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN15769 Alonso, Zenaida*
NPI: 1275586836 LIC: DN15769
CERTIFICATIONS :
# DN20993 Alwehaib, Arwa*
NPI: 1922498070 LIC: DN20993
CERTIFICATIONS :
# DN19227 Bentsi-Enchill, Flora*
NPI: 1669778353 LIC: DN19227
CERTIFICATIONS :
# DN19634 Cucuras, John*
NPI: 1891876322 LIC: DN19634
CERTIFICATIONS :
# DN17819 Momin, Aysha*
NPI: 1649319690 LIC: DN17819
CERTIFICATIONS :
# DN22922 Oliveira, Paulo*
NPI: 1285157826 LIC: DN22922
CERTIFICATIONS :
# DN8969 Rotella, Robert*
NPI: 1447320544 LIC: DN8969
CERTIFICATIONS :
# DN17452 Seminario, Ada*
NPI: 1104921592 LIC: DN17452
CERTIFICATIONS :
#FQHC016394
CL Brumback Primary Care
Clinics
1250 Southwinds Dr
Lantana, FL 33462
(561) 370-1306
Special Needs: Yes
Creoles and Pidgins
English-based(other), English,
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15769 Alonso, Zenaida*
NPI: 1275586836 LIC: DN15769
CERTIFICATIONS :
# DN20993 Alwehaib, Arwa*
NPI: 1922498070 LIC: DN20993
CERTIFICATIONS :
# DN19227 Bentsi-Enchill, Flora*
NPI: 1669778353 LIC: DN19227
CERTIFICATIONS :
# DN19634 Cucuras, John*
NPI: 1891876322 LIC: DN19634
CERTIFICATIONS :
# DN17819 Momin, Aysha*
NPI: 1649319690 LIC: DN17819
CERTIFICATIONS :
# DN22922 Oliveira, Paulo*
NPI: 1285157826 LIC: DN22922
CERTIFICATIONS :
# DN8969 Rotella, Robert*
NPI: 1447320544 LIC: DN8969
CERTIFICATIONS :
# DN17452 Seminario, Ada*
NPI: 1104921592 LIC: DN17452
CERTIFICATIONS :
#FQHC016395
CL Brumback Primary Care
Clinics
225 S. Congress Ave
Delray Beach, FL 33445
hcdpbc.org
(561) 642-1000
Special Needs: Yes
Farsi, Creoles and Pidgins (other),
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15769 Alonso, Zenaida*
NPI: 1275586836 LIC: DN15769
CERTIFICATIONS :
# DN20993 Alwehaib, Arwa*
NPI: 1922498070 LIC: DN20993
CERTIFICATIONS :
# DN19227 Bentsi-Enchill, Flora*
NPI: 1669778353 LIC: DN19227
CERTIFICATIONS :
# DN19634 Cucuras, John*
NPI: 1891876322 LIC: DN19634
CERTIFICATIONS :
# DN17819 Momin, Aysha*
NPI: 1649319690 LIC: DN17819
CERTIFICATIONS :
# DN22922 Oliveira, Paulo*
NPI: 1285157826 LIC: DN22922
CERTIFICATIONS :
# DN8969 Rotella, Robert*
NPI: 1447320544 LIC: DN8969
CERTIFICATIONS :
# DN17452 Seminario, Ada*
NPI: 1104921592 LIC: DN17452
CERTIFICATIONS :
#006577
Cross County Dental
4288 Okeechobee Blvd
West Palm Beach, FL 33409
(561) 683-6247
Special Needs: Yes
Russian, Spanish
M-T 10am-5pm
W 8am-5pm, Th 10am-5pm,F
10am-2pm
S 9am - 2pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 64 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#CHC015386
DOH - Palm Beach Cty Hlth Dept-
REFERRAL BASED LOCATION
ONLY
851 Ave P
Riviera Beach, FL 33404
(561) 803-7352
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN11165 Staten, William*
NPI: 1114029170 LIC: DN11165
CERTIFICATIONS :
# DN8637 Woersching, Douglas*
NPI: 1598871758 LIC: DN8637
CERTIFICATIONS :
#013217
Dr. Michael D. Quasha
4520 Donald Ross Road, Ste 105
Palm Beach Gardens, FL 33418
(561) 799-5558
Special Needs:
English, Arabic, French, Spanish
M-T 9am-4pm
W-F 9am-4pm
# DN16005 Quasha, Michael
NPI: 1972674448 LIC: DN16005
CERTIFICATIONS :
#006676
Florida Dental & Denture Center
1901 S. Federal Hwy
Boynton Beach, FL 33435
(561) 738-5974
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN13168 Semeah, Yves
NPI: 1326152463 LIC: DN13168
CERTIFICATIONS :
#006678
Florida Dental & Denture Center
III
2945 N. Australian Ave
West Palm Beach, FL 33407
(561) 844-0033
Special Needs: No
Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN8737 Newman, Donald
NPI: 1356476857 LIC: DN8737
CERTIFICATIONS :
# DN13168 Semeah, Yves
NPI: 1326152463 LIC: DN13168
CERTIFICATIONS :
#FQHC014906
Foundcare, Inc.
2330 S. Congress Ave
West Palm Beach, FL 33406
(561) 432-5849
Special Needs: Yes
English, Arabic, Creoles and Pidgins
French-based(other), French, Spanish
M 8am - 5pm, T 8am - 7pm
W-F 8am-5pm
# DN23592 Lacroze, Dorotie
NPI: 1104329978 LIC: DN23592
CERTIFICATIONS :
# DN12194 Rampertaap, Maheswar
NPI: 1235290602 LIC: DN12194
CERTIFICATIONS :
#FQHC014974
Genesis Community Health Inc
181 Crawford Blvd
Boca Raton, FL 33432
(561) 235-5477
Special Needs: Yes
English, Spanish, Creoles and Pidgins
(other)
T 8am - 5pm
W-Th 8am-5pm
# DN20219 Elkind, Jaime
NPI: 1437567146 LIC: DN20219
CERTIFICATIONS :
# DN21026 Kniznik, Carla
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 65 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1811134612 LIC: DN21026
CERTIFICATIONS :
# DN18189 Rizzardi, Suzanne
NPI: 1861666232 LIC: DN18189
CERTIFICATIONS :
#FQHC017622
Genesis Community Health, Inc.
2623 S. Seacrest Blvd Ste 112
Boynton Beach, FL 33435
(561) 810-8790
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN20219 Elkind, Jaime
NPI: 1437567146 LIC: DN20219
CERTIFICATIONS :
# DN21026 Kniznik, Carla
NPI: 1811134612 LIC: DN21026
CERTIFICATIONS :
# DN18189 Rizzardi, Suzanne
NPI: 1861666232 LIC: DN18189
CERTIFICATIONS :
#021605
Greenberg Dental & Orthodontics
701 N. Congress Ave, Ste 9
Boynton Beach, FL 33426
(561) 740-2013
Special Needs: Yes
English, Spanish
M 8am - 4pm, T 11am - 7pm
W 8am-4pm, Th 11am-7pm,F
8am-4pm
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN18753 Daneshpajouh, Sara
NPI: 1982836003 LIC: DN18753
CERTIFICATIONS :
# DN22704 Foreman, Kathleen
NPI: 1407377724 LIC: DN22704
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN23796 Lajevardi, Navid
NPI: 1194212472 LIC: DN23796
CERTIFICATIONS :
# DN24103 Neyra, Arlet
NPI: 1730747833 LIC: DN24103
CERTIFICATIONS :
# DN22692 Nguyen, Josie
NPI: 1548790801 LIC: DN22692
CERTIFICATIONS :
• Inhalation Sedation
• Oral / Enteral Sedation
# DN23069 Piccione, Francesco
NPI: 1295274835 LIC: DN23069
CERTIFICATIONS :
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
# DN22428 Salehi, Shiva
NPI: 1346696549 LIC: DN22428
CERTIFICATIONS :
# DN20824 Scarlett, Francesca
NPI: 1124437884 LIC: DN20824
CERTIFICATIONS :
# DN17455 Stein, Stacy
NPI: 1467637561 LIC: DN17455
CERTIFICATIONS :
# DN23211 Walker, Lindsay
NPI: 1093238842 LIC: DN23211
CERTIFICATIONS :
#022594
Habashy Dental of Palm Beach
Gardens - Jupiter
4595 Northlake Blvd, Ste 103 & 114
Palm Beach Gardens, FL 33418
(561) 427-7711
Special Needs: Yes
English, Arabic, Spanish
M-T 8am-8pm
W-F 8am-8pm
S 8am - 5pm
# DN22543 Habashy, Peter
NPI: 1760919898 LIC: DN22543
CERTIFICATIONS :
#020193
Heavenly Smiles
135 South Us Highway 27
South Bay, FL 33493
(561) 996-0033
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 9am-5pm
W-Th 9am-5pm
# DN21975 Baldwin, Anthony
NPI: 1073066551 LIC: DN21975
CERTIFICATIONS :
#016856
Jaime R. Marquez DDS PA
7301A W. Palmetto Pk Road, Ste
204-A
Boca Raton, FL 33433
brocadentalsedationgroup.com
(561) 391-1114
Special Needs: Yes
English, Russian, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# DN20355 Marquez, Jaime
NPI: 1750442992 LIC: DN20355
CERTIFICATIONS :
• Conscious Sedation
#019498
Lidia Suarez DDS Inc
1800 Forest Hill Blvd #A3-4
West Palm Beach, FL 33406
www.suarezlidiadds.com
(561) 249-6114
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN20107 Suarez Tabares, Lidia
NPI: 1780976795 LIC: DN20107
CERTIFICATIONS :
#021850
Nona Diamond Dental LLC
1696 S. Military Trail # B
West Palm Beach, FL 33415
(561) 791-6494
Special Needs: Yes
English, Spanish, Portuguese
M-T 8am-5pm
W-Th 8am-5pm
S 8am - 1pm
# DN20957 Correa, Ali
NPI: 1972815835 LIC: DN20957
CERTIFICATIONS :
#021802
Pediatric & General Dentistry of
Palm Beach
1620 S. Congress Ave, Ste 102
Palm Springs, FL 33461
(561) 508-5930
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 1pm
# DN23641 Moynelo, Camilo*
NPI: 1376039115 LIC: DN23641
CERTIFICATIONS :
#007645
Polo Dental
1905 Clint Moore Rd, Ste 200
Boca Raton, FL 33496
(561) 241-7656
Special Needs: Yes
English, Russian, Creoles and Pidgins
French-based(other), Spanish
M 11am - 7pm, T 9am - 5pm
Th-F 9am-5pm
# DN23676 Aldaya, Robair
NPI: 1508344599 LIC: DN23676
CERTIFICATIONS :
# DN23633 Andrade, Emily
NPI: 1407335409 LIC: DN23633
CERTIFICATIONS :
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
CERTIFICATIONS :
# DN17996 Etemadshahidi, Babak
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 66 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1336300805 LIC: DN17996
CERTIFICATIONS :
# DN24425 Faizzadeh, Paula
NPI: 1912550799 LIC: DN24425
CERTIFICATIONS :
# DN23511 Nguyen, Chi
NPI: 1811482656 LIC: DN23511
CERTIFICATIONS :
• Inhalation Sedation
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
# DN24429 Shahriari, Varahram
NPI: 1952954778 LIC: DN24429
CERTIFICATIONS :
# DN16481 Zadov, Marianna
NPI: 1104903301 LIC: DN16481
CERTIFICATIONS :
• Inhalation Sedation
#014988
Polo Dental
4700 N. Congress Ave, Ste 302
West Palm Beach, FL 33407
(561) 666-9691
Special Needs: Yes
English, Russian, Creoles and Pidgins
English-based(other), Spanish
M 9am - 5pm, T 10am - 6pm
W-F 10am-6pm
# DN23676 Aldaya, Robair
NPI: 1508344599 LIC: DN23676
CERTIFICATIONS :
# DN23633 Andrade, Emily
NPI: 1407335409 LIC: DN23633
CERTIFICATIONS :
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
CERTIFICATIONS :
# DN17996 Etemadshahidi, Babak
NPI: 1336300805 LIC: DN17996
CERTIFICATIONS :
# DN24425 Faizzadeh, Paula
NPI: 1912550799 LIC: DN24425
CERTIFICATIONS :
# DN23511 Nguyen, Chi
NPI: 1811482656 LIC: DN23511
CERTIFICATIONS :
• Inhalation Sedation
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
# DN24429 Shahriari, Varahram
NPI: 1952954778 LIC: DN24429
CERTIFICATIONS :
# DN16481 Zadov, Marianna
NPI: 1104903301 LIC: DN16481
CERTIFICATIONS :
• Inhalation Sedation
#008259
Premiere Dental Care, PL
600 S Dixie Hwy, Ste 105
West Palm Beach, FL 33401
(561) 820-8898
Special Needs: Yes
English, Chinese Mandarin, Russian,
Spanish
M 9am - 5pm, T 9am - 6pm
W 9am-6pm, Th 9am-5pm,F 9am-6pm
# DN15966 Elperin, Alexei
NPI: 1295930063 LIC: DN15966
CERTIFICATIONS :
# DN12723 Hui, Tin
NPI: 1952408619 LIC: DN12723
CERTIFICATIONS :
#013199
Professional Dental Team, PA
5100 South Dixie Highway, Ste #2
West Palm Beach, FL 33405
(561) 721-2525
Special Needs: Yes
English, Spanish
M-T 9am-5pm
Th-F 9am-5pm
# DN18296 Galindo, Olga
NPI: 1396903746 LIC: DN18296
CERTIFICATIONS :
#010039
Quantum Dental
1034 Gateway Blvd, Ste 101
Boynton Beach, FL 33426
(561) 249-2585
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN17323 Deyab, Tim
NPI: 1124119474 LIC: DN17323
CERTIFICATIONS :
#016245
Royal Dental
1301 N. Congress, Ste 110
Boynton Beach, FL 33426
(561) 292-0155
Special Needs: Yes
English, Russian, Spanish
M-T 9am-5pm
W 9am-5pm, Th 10am-6pm,F
9am-5pm
# DN23676 Aldaya, Robair
NPI: 1508344599 LIC: DN23676
CERTIFICATIONS :
# DN23633 Andrade, Emily
NPI: 1407335409 LIC: DN23633
CERTIFICATIONS :
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
CERTIFICATIONS :
# DN17996 Etemadshahidi, Babak
NPI: 1336300805 LIC: DN17996
CERTIFICATIONS :
# DN24425 Faizzadeh, Paula
NPI: 1912550799 LIC: DN24425
CERTIFICATIONS :
# DN15662 Gordon, Robert
NPI: 1578582359 LIC: DN15662
CERTIFICATIONS :
# DN23511 Nguyen, Chi
NPI: 1811482656 LIC: DN23511
CERTIFICATIONS :
• Inhalation Sedation
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
# DN24429 Shahriari, Varahram
NPI: 1952954778 LIC: DN24429
CERTIFICATIONS :
# DN16481 Zadov, Marianna
NPI: 1104903301 LIC: DN16481
CERTIFICATIONS :
• Inhalation Sedation
#009637
Sage Dental of Belle Glade, P.A.
427 Se 2Nd St
Belle Glade, FL 33430
(561) 996-6006
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN19079 Fernandez-Martinez,
Mariangel*
NPI: 1376857441 LIC: DN19079
CERTIFICATIONS :
# DN21989 Leminh, Chau*
NPI: 1063863322 LIC: DN21989
CERTIFICATIONS :
# DN18330 Naguib, Michelle*
NPI: 1215170980 LIC: DN18330
CERTIFICATIONS :
• Inhalation Sedation
# DN17837 Snider, Erica*
NPI: 1073702767 LIC: DN17837
CERTIFICATIONS :
#015450
Sky Dental
625 Se 2Nd Ave, Ste D
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 67 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Boynton Beach, FL 33435
(561) 739-3222
Special Needs: No
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN14857 Gonzalez-Fujara, Maria
NPI: 1922133099 LIC: DN14857
CERTIFICATIONS :
ENDODONTICS
#006577
Cross County Dental
4288 Okeechobee Blvd
West Palm Beach, FL 33409
(561) 683-6247
Special Needs: Yes
Russian, Spanish
M-T 10am-5pm
W 8am-5pm, Th 10am-5pm,F
10am-2pm
S 9am - 2pm
# DN13421 Gittess, Robert
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
ORAL SURGEON
#020366
Florida Dental For Oral Surgery
& Dental Implants
4953 Lechalet Blvd, Ste 1
Boynton Beach, FL 33436
(954) 838-0621
Special Needs: Yes
English, Spanish, Creoles and Pidgins
(other), French
M-T 9am-5pm
W-Th 9am-5pm
# DN16448 Smith, Damone*
NPI: 1780718411 LIC: DN16448
CERTIFICATIONS :
• Conscious Sedation
• General Anesthesia
• Inhalation Sedation
• Intravenous Sedation
• Oral / Enteral Sedation
• Pediatric Conscious Sedation
#009172
John R. Pasqual, DMD, PA
4600 Linton Blvd, Ste 220
Delray Beach, FL 33445
(561) 900-9080
Special Needs: Yes
English
M-T 9am-5pm
W-F 9am-5pm
# DN17270 Pasqual, John*
NPI: 1124000575 LIC: DN17270
CERTIFICATIONS :
• Board Certification
• General Anesthesia
PEDIATRIC DENTISTRY
#FQHC016392
CL Brumback Primary Care
Clinics
39200 Hooker Highway, Ste 101
Belle Glade, FL 33430
(561) 370-1300
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19391 Zangeneh, Yasmine*
NPI: 1841586567 LIC: DN19391
CERTIFICATIONS :
#FQHC016393
CL Brumback Primary Care
Clinics
1150 45Th St
West Palm Beach, FL 33407
(561) 370-1300
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN19391 Zangeneh, Yasmine*
NPI: 1841586567 LIC: DN19391
CERTIFICATIONS :
#FQHC016394
CL Brumback Primary Care
Clinics
1250 Southwinds Dr
Lantana, FL 33462
(561) 370-1306
Special Needs: Yes
Creoles and Pidgins
English-based(other), English,
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19391 Zangeneh, Yasmine*
NPI: 1841586567 LIC: DN19391
CERTIFICATIONS :
#FQHC016395
CL Brumback Primary Care
Clinics
225 S. Congress Ave
Delray Beach, FL 33445
hcdpbc.org
(561) 642-1000
Special Needs: Yes
Farsi, Creoles and Pidgins (other),
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19391 Zangeneh, Yasmine*
NPI: 1841586567 LIC: DN19391
CERTIFICATIONS :
PERIODONTICS
#006577
Cross County Dental
4288 Okeechobee Blvd
West Palm Beach, FL 33409
(561) 683-6247
Special Needs: Yes
Russian, Spanish
M-T 10am-5pm
W 8am-5pm, Th 10am-5pm,F
10am-2pm
S 9am - 2pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
#007645
Polo Dental
1905 Clint Moore Rd, Ste 200
Boca Raton, FL 33496
(561) 241-7656
Special Needs: Yes
English, Russian, Creoles and Pidgins
French-based(other), Spanish
M 11am - 7pm, T 9am - 5pm
Th-F 9am-5pm
# DN23115 Mendoza, Juan
NPI: 1821326430 LIC: DN23115
CERTIFICATIONS :
• Inhalation Sedation
# DN11699 Simon, David
NPI: 1508303587 LIC: DN11699
CERTIFICATIONS :
• Oral / Enteral Sedation
#014988
Polo Dental
4700 N. Congress Ave, Ste 302
West Palm Beach, FL 33407
(561) 666-9691
Special Needs: Yes
English, Russian, Creoles and Pidgins
English-based(other), Spanish
M 9am - 5pm, T 10am - 6pm
W-F 10am-6pm
# DN23115 Mendoza, Juan
NPI: 1821326430 LIC: DN23115
CERTIFICATIONS :
• Inhalation Sedation
# DN11699 Simon, David
NPI: 1508303587 LIC: DN11699
CERTIFICATIONS :
• Oral / Enteral Sedation
#016245
Royal Dental
1301 N. Congress, Ste 110
Boynton Beach, FL 33426
(561) 292-0155
Special Needs: Yes
English, Russian, Spanish
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 68 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
M-T 9am-5pm
W 9am-5pm, Th 10am-6pm,F
9am-5pm
# DN23115 Mendoza, Juan
NPI: 1821326430 LIC: DN23115
CERTIFICATIONS :
• Inhalation Sedation
# DN11699 Simon, David
NPI: 1508303587 LIC: DN11699
CERTIFICATIONS :
• Oral / Enteral Sedation
PASCO COUNTY
DENTIST
#FQHC014534
Premier Community HealthCare
Group Inc.
2114 Seven Springs Blvd
New Port Richey, FL 34655
(352) 518-2000
Special Needs: Yes
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# DN11556 Baker, Wayne
NPI: 1699833947 LIC: DN11556
CERTIFICATIONS :
# HAD33 Modaff, Michelle*
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN19998 Nazco-Batista, Maria
NPI: 1093050676 LIC: DN19998
CERTIFICATIONS :
• Inhalation Sedation
# DN20707 Painter, Lisa
NPI: 1083031926 LIC: DN20707
CERTIFICATIONS :
# DN13891 Peralta, Jose*
NPI: 1962462036 LIC: DN13891
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC011082
Premier Community HealthCare
Group, Inc.
37944 Pasco Ave
Dade City, FL 33525
PREMIERHC.ORG
(352) 518-2000
Special Needs: Yes
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# DN24159 Au, Anna
NPI: 1174182463 LIC: DN24159
CERTIFICATIONS :
# DN11556 Baker, Wayne
NPI: 1699833947 LIC: DN11556
CERTIFICATIONS :
# DN14806 Barinas-Duval, Froilan
NPI: 1699748442 LIC: DN14806
CERTIFICATIONS :
• Inhalation Sedation
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN19998 Nazco-Batista, Maria
NPI: 1093050676 LIC: DN19998
CERTIFICATIONS :
• Inhalation Sedation
# DN20707 Painter, Lisa
NPI: 1083031926 LIC: DN20707
CERTIFICATIONS :
# DN13891 Peralta, Jose
NPI: 1962462036 LIC: DN13891
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
ORAL SURGEON
#012639
Tampa Bay Institute of Oral
Surgery & Dental Implants
19445 Shumard Oak Dr Ste 101
Land O Lakes, FL 34638
https://tampabayos.com
(813) 909-2354
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN18163 Aves, Renato
NPI: 1336322650 LIC: DN18163
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN19301 Caribas-Mendible,
Alejandro
NPI: 1013204122 LIC: DN19301
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN23977 Elmohd, Tarik
NPI: 1538556329 LIC: DN23977
CERTIFICATIONS :
PINELLAS COUNTY
DENTIST
#011420
A-1 Dental
29605 Us 19 North, Ste 350
Clearwater, FL 33761
(727) 786-6649
Special Needs: No
English, Gujarati, Hindi
M 9am - 5pm, T 10am - 6pm
F 9am-5pm
# DN11504 Patel, Guarangi*
NPI: 1326123993 LIC: DN11504
CERTIFICATIONS :
#FQHC011250
Community Health Centers of
Pinellas, Inc
1344 22Nd Street S
St Petersburg, FL 33712
(727) 824-8181
Special Needs: Yes
English, Spanish
M-T 7am-6pm
W-Th 7am-6pm
# DN21300 Alonso, Anamevys
NPI: 1669868147 LIC: DN21300
CERTIFICATIONS :
# DN22253 Carter, Jade
NPI: 1487968467 LIC: DN22253
CERTIFICATIONS :
# DN19885 Dougherty, Erin
NPI: 1043565807 LIC: DN19885
CERTIFICATIONS :
# DN9873 Lansmann, Richard
NPI: 1427355585 LIC: DN9873
CERTIFICATIONS :
# DN21962 Trenkova, Violeta
NPI: 1841641792 LIC: DN21962
CERTIFICATIONS :
#FQHC011251
Community Health Centers of
Pinellas, Inc
702 Jasmine Way
Clearwater, FL 33756
(727) 824-8181
Special Needs: Yes
English, Spanish
M 7am - 6pm, T 7am - 4pm
W 7am-4pm, Th 7am-6pm,F 7am-4pm
# DN21300 Alonso, Anamevys
NPI: 1669868147 LIC: DN21300
CERTIFICATIONS :
# DN22253 Carter, Jade
NPI: 1487968467 LIC: DN22253
CERTIFICATIONS :
# DN19885 Dougherty, Erin
NPI: 1043565807 LIC: DN19885
CERTIFICATIONS :
# DN9873 Lansmann, Richard
NPI: 1427355585 LIC: DN9873
CERTIFICATIONS :
# DN21962 Trenkova, Violeta
NPI: 1841641792 LIC: DN21962
CERTIFICATIONS :
#022289
Countryside Mall Dental PA
27001 Us Highway 19 N, Ste 1031B
Clearwater, FL 33761
(727) 669-1600
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 69 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Special Needs: Yes
English, Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S 10am - 9pm, Su 11am - 6pm
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
#CHC10109
DOH - Pinellas County Health
Department
205 Dr. Martin Luther King St No.
Saint Petersburg, FL 33701
(727) 824-6900
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN12823 Beers, Eda
NPI: 1437118460 LIC: DN12823
CERTIFICATIONS :
• Inhalation Sedation
# DN12874 Chekan, Theodore
NPI: 1992750426 LIC: DN12874
CERTIFICATIONS :
# DN13061 Engelman, Sharon
NPI: 1215996384 LIC: DN13061
CERTIFICATIONS :
# DN18300 Gatons, Yelena
NPI: 1326202474 LIC: DN18300
CERTIFICATIONS :
# DN12521 Lense, Pedro
NPI: 1154380913 LIC: DN12521
CERTIFICATIONS :
# DN18737 Luce, Amy
NPI: 1770888059 LIC: DN18737
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
# DN11690 Saraydar, Haychell
NPI: 1750343257 LIC: DN11690
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
# DN11179 Wong, Elaine
NPI: 1295794360 LIC: DN11179
CERTIFICATIONS :
#CHC10125
DOH - Pinellas County Health
Department
8751 Ulmerton Rd
Largo, FL 33771
(727) 524-4410
Special Needs: Yes
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN12823 Beers, Eda
NPI: 1437118460 LIC: DN12823
CERTIFICATIONS :
• Inhalation Sedation
# DN12874 Chekan, Theodore
NPI: 1992750426 LIC: DN12874
CERTIFICATIONS :
# DN13061 Engelman, Sharon
NPI: 1215996384 LIC: DN13061
CERTIFICATIONS :
# DN18300 Gatons, Yelena
NPI: 1326202474 LIC: DN18300
CERTIFICATIONS :
# DN11984 Gonzalez, Jose
NPI: 1992706691 LIC: DN11984
CERTIFICATIONS :
# DN12521 Lense, Pedro
NPI: 1154380913 LIC: DN12521
CERTIFICATIONS :
# DN11690 Saraydar, Haychell
NPI: 1750343257 LIC: DN11690
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
# DN11179 Wong, Elaine
NPI: 1295794360 LIC: DN11179
CERTIFICATIONS :
#CHC10126
DOH - Pinellas County Health
Department
12420 130Th Ave North
Largo, FL 33774
(727) 824-6900
Special Needs: Yes
Spanish, English
# DN12823 Beers, Eda*
NPI: 1437118460 LIC: DN12823
CERTIFICATIONS :
• Inhalation Sedation
# DN12874 Chekan, Theodore
NPI: 1992750426 LIC: DN12874
CERTIFICATIONS :
# DN13061 Engelman, Sharon*
NPI: 1215996384 LIC: DN13061
CERTIFICATIONS :
# DN18300 Gatons, Yelena*
NPI: 1326202474 LIC: DN18300
CERTIFICATIONS :
# DN12521 Lense, Pedro
NPI: 1154380913 LIC: DN12521
CERTIFICATIONS :
# DN11690 Saraydar, Haychell*
NPI: 1750343257 LIC: DN11690
CERTIFICATIONS :
# DN19476 Thomas, Kelly*
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
# DN17405 Ward, Tasha*
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
# DN11179 Wong, Elaine*
NPI: 1295794360 LIC: DN11179
CERTIFICATIONS :
#CHC10127
DOH - Pinellas County Health
Department
6350 76Th Ave North
Pinellas Park, FL 33781
(727) 547-7780
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN12823 Beers, Eda
NPI: 1437118460 LIC: DN12823
CERTIFICATIONS :
• Inhalation Sedation
# DN12874 Chekan, Theodore
NPI: 1992750426 LIC: DN12874
CERTIFICATIONS :
# DN13061 Engelman, Sharon
NPI: 1215996384 LIC: DN13061
CERTIFICATIONS :
# DN18300 Gatons, Yelena
NPI: 1326202474 LIC: DN18300
CERTIFICATIONS :
# DN11984 Gonzalez, Jose
NPI: 1992706691 LIC: DN11984
CERTIFICATIONS :
# DN12521 Lense, Pedro
NPI: 1154380913 LIC: DN12521
CERTIFICATIONS :
# DN11690 Saraydar, Haychell
NPI: 1750343257 LIC: DN11690
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
# DN11179 Wong, Elaine
NPI: 1295794360 LIC: DN11179
CERTIFICATIONS :
#CHC10128
DOH - Pinellas County Health
Department
301 S. Disston Ave
Tarpon Springs, FL 34689
(727) 485-1805
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 70 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Special Needs: Yes
English, Spanish
M 8am - 5pm,
W 8am-5pm,
# DN12823 Beers, Eda
NPI: 1437118460 LIC: DN12823
CERTIFICATIONS :
• Inhalation Sedation
# DN12874 Chekan, Theodore
NPI: 1992750426 LIC: DN12874
CERTIFICATIONS :
# DN13061 Engelman, Sharon
NPI: 1215996384 LIC: DN13061
CERTIFICATIONS :
# DN18300 Gatons, Yelena
NPI: 1326202474 LIC: DN18300
CERTIFICATIONS :
# DN12521 Lense, Pedro
NPI: 1154380913 LIC: DN12521
CERTIFICATIONS :
# DN11690 Saraydar, Haychell
NPI: 1750343257 LIC: DN11690
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
# DN11179 Wong, Elaine
NPI: 1295794360 LIC: DN11179
CERTIFICATIONS :
#CHC10129
DOH - Pinellas County Health
Department
310 N. Myrtle Ave
Clearwater, FL 33755
(727) 275-6535
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN12823 Beers, Eda
NPI: 1437118460 LIC: DN12823
CERTIFICATIONS :
• Inhalation Sedation
# DN12874 Chekan, Theodore
NPI: 1992750426 LIC: DN12874
CERTIFICATIONS :
# DN13061 Engelman, Sharon
NPI: 1215996384 LIC: DN13061
CERTIFICATIONS :
# DN18300 Gatons, Yelena
NPI: 1326202474 LIC: DN18300
CERTIFICATIONS :
# DN12521 Lense, Pedro
NPI: 1154380913 LIC: DN12521
CERTIFICATIONS :
# DN11690 Saraydar, Haychell
NPI: 1750343257 LIC: DN11690
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
# DN11179 Wong, Elaine
NPI: 1295794360 LIC: DN11179
CERTIFICATIONS :
#010840
St. Petersburg Dental Clinic
9200 113Th Street N.
Seminole, FL 33772
(727) 394-6064
Special Needs: Yes
English, Spanish
M-T 7am-4pm
W-F 7am-4pm
# DN8905 Porter, Thomas
NPI: 1578520375 LIC: DN8905
CERTIFICATIONS :
• Conscious Sedation
• Inhalation Sedation
# DN18620 Viera, Gretel
NPI: 1790915635 LIC: DN18620
CERTIFICATIONS :
#016551
Suarez Cosmetic Dentistry
3801 Park St N Ste 1
Saint Petersburg, FL 33709
(727) 440-6488
Special Needs: Yes
English, Spanish
T 9am - 5pm
W-Th 9am-5pm
# DN21413 Suarez-Zayas, Yoan*
NPI: 1457734535 LIC: DN21413
CERTIFICATIONS :
• Inhalation Sedation
#011546
Tyrone Square Mall Dental PA
6747 Tyrone Square
Saint Petersburg, FL 33710
(727) 345-6100
Special Needs: Yes
English, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 71 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN22695 Toribio Fabelo, Leydy
NPI: 1033639554 LIC: DN22695
CERTIFICATIONS :
• Inhalation Sedation
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
PERIODONTICS
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
POLK COUNTY
DENTIST
#CHC7919
Central Florida Health Care
109 W. Wall St
Frostproof, FL 33843
(863) 635-4891
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other), French
M-T 7am-5pm
W-F 7am-5pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
#CHC7921
Central Florida Health Care
305 W. Central Ave
Lake Wales, FL 33853
(863) 855-9718
Special Needs: Yes
Spanish, English
M-T 7am-5pm
W-F 7am-5pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN24008 Pettit, Karen
NPI: 1285123414 LIC: DN24008
CERTIFICATIONS :
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#FQHC020824
Central Florida Health Care, Inc
601 S. Florida Ave, Ste 6
Lakeland, FL 33801
(866) 234-8534
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 7am-6pm
Th-F 7am-6pm
# DN24008 Pettit, Karen
NPI: 1285123414 LIC: DN24008
CERTIFICATIONS :
#FQHC021227
Central Florida Health Care, Inc
705 Ingraham Ave
Haines City, FL 33844
(863) 438-6900
Special Needs: Yes
English, Spanish, Creoles and Pidgins
English-based(other)
M-T 7am-6pm
W-Th 7am-6pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 72 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
# DN15069 Suri, Niki
NPI: 1316129182 LIC: DN15069
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#FQHC011909
Central Florida Health Care, Inc.
1514 1St St North
Winter Haven, FL 33881
(866) 234-8534
Special Needs: Yes
Spanish, English, Creoles and Pidgins
French-based(other)
M-T 7am-6pm
W-Th 7am-6pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
#FQHC012686
Central Florida Health Care, Inc.
106 Nw 9Th Ave
Mulberry, FL 33860
(863) 425-6200
Special Needs: Yes
English, Spanish
M-T 7am-6pm
W-F 7am-6pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana*
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN12871 Cardenas, Carlos*
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla*
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis*
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela*
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise*
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph*
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen*
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle*
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN22245 Rubin, Joslyn*
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas*
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
# DN17405 Ward, Tasha*
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#FQHC015864
Central Florida Health Care, Inc.
201 Magnolia Ave Sw
Winter Haven, FL 33880
www.cfhconline.org
(866) 234-8534
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 7am-5pm
W-F 7am-5pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN12668 Congote, Luis
NPI: 1679774426 LIC: DN12668
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN20914 Hackstie, Joseph
NPI: 1932508405 LIC: DN20914
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#CHC10104
DOH - Polk County Health
Department
1805 Hobbs Road
Auburndale, FL 33823
(863) 519-7910
Special Needs: Yes
English, Spanish, Sign Languages
M-T 8am-5pm
W-F 8am-5pm
# DN11009 Ebner, Stephen
NPI: 1578652442 LIC: DN11009
CERTIFICATIONS :
• Inhalation Sedation
# DN15480 Rodriguez, Ana
NPI: 1184835985 LIC: DN15480
CERTIFICATIONS :
• Inhalation Sedation
# DN19400 Santos, Luis
NPI: 1821152232 LIC: DN19400
CERTIFICATIONS :
• Inhalation Sedation
#CHC10105
DOH - Polk County Health
Department
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 73 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
1700 Baker Ave East
Haines City, FL 33844
(863) 519-7910
Special Needs: Yes
English, Spanish
M 8am - 5pm, T 8am - 7pm
W-F 8am-5pm
# DN11009 Ebner, Stephen
NPI: 1578652442 LIC: DN11009
CERTIFICATIONS :
• Inhalation Sedation
# DN15480 Rodriguez, Ana
NPI: 1184835985 LIC: DN15480
CERTIFICATIONS :
• Inhalation Sedation
# DN19400 Santos, Luis
NPI: 1821152232 LIC: DN19400
CERTIFICATIONS :
• Inhalation Sedation
#CHC10106
DOH - Polk County Health
Department
2090 E. Clower St
Bartow, FL 33830
(863) 534-7258
Special Needs: Yes
Spanish, English
M-T 8am-5pm
W 7am-5pm, Th 8am-5pm,F 7am-5pm
# DN11009 Ebner, Stephen
NPI: 1578652442 LIC: DN11009
CERTIFICATIONS :
• Inhalation Sedation
# DN15480 Rodriguez, Ana
NPI: 1184835985 LIC: DN15480
CERTIFICATIONS :
• Inhalation Sedation
# DN19400 Santos, Luis
NPI: 1821152232 LIC: DN19400
CERTIFICATIONS :
• Inhalation Sedation
#CHC10107
DOH - Polk County Health
Department
3241 Lakeland Hills Blvd
Lakeland, FL 33805
(863) 519-7910
Special Needs: Yes
English, Spanish, Creoles and Pidgins
French-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN11009 Ebner, Stephen
NPI: 1578652442 LIC: DN11009
CERTIFICATIONS :
• Inhalation Sedation
# DN15480 Rodriguez, Ana
NPI: 1184835985 LIC: DN15480
CERTIFICATIONS :
• Inhalation Sedation
# DN19400 Santos, Luis
NPI: 1821152232 LIC: DN19400
CERTIFICATIONS :
• Inhalation Sedation
#007727
Mulberry Dental Care, Inc
105 N. Church Ave
Mulberry, FL 33860
(863) 869-8888
Special Needs: Yes
English, Farsi, French, Persian (T),
Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN13817 Farzaneh, Masoud
NPI: 1669544540 LIC: DN13817
CERTIFICATIONS :
# DN13663 Shafii, Fariba
NPI: 1558433490 LIC: DN13663
CERTIFICATIONS :
#022832
Ricardo Carlo Carrillo-Giraldo
1020 5Th Street Se
Winter Haven, FL 33880
(863) 299-2374
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN23339 Carrillo Giraldo, Ricardo
NPI: 1174979991 LIC: DN23339
CERTIFICATIONS :
ORAL SURGEON
#022551
Tampa Bay Institute of Oral
Surgery & Dental Implants
1301 Grasslands Blvd, Ste 200
Lakeland, FL 33803
(863) 648-6555
Special Needs: Yes
English, Spanish
M-T 7am-4pm
W-Th 7am-4pm
# DN18163 Aves, Renato
NPI: 1336322650 LIC: DN18163
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN23977 Elmohd, Tarik
NPI: 1538556329 LIC: DN23977
CERTIFICATIONS :
# DN21438 Kalsow, Oleg
NPI: 1275951972 LIC: DN21438
CERTIFICATIONS :
# DN19378 Samaniego, Juan
NPI: 1467692129 LIC: DN19378
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN16473 Walcott, Sean
NPI: 1841250743 LIC: DN16473
CERTIFICATIONS :
• General Anesthesia
PUTNAM COUNTY
DENTIST
#FQHC010441
Azalea Health
2503 President Street
Palatka, FL 32177
(386) 328-7638
Special Needs: Yes
English, Spanish
M-T 8am-7pm
W-Th 8am-7pm
# DN21424 Budzinski, Volha
NPI: 1588047468 LIC: DN21424
CERTIFICATIONS :
# DN15770 Halady, Pratima
NPI: 1720256811 LIC: DN15770
CERTIFICATIONS :
# HAD56 Krotzinger, Mary
NPI: 1992796973 LIC: HAD56
CERTIFICATIONS :
# DN20873 Lopez, Melvin
NPI: 1689081242 LIC: DN20873
CERTIFICATIONS :
# DN12941 Pairot, Alfredo
NPI: 1932174448 LIC: DN12941
CERTIFICATIONS :
# DN8746 Saraga, David
NPI: 1780805028 LIC: DN8746
CERTIFICATIONS :
#CHC10218
DOH - Putnam County Health
Department
2801 Kennedy Street
Palatka, FL 32177
(386) 326-3336
Special Needs: Yes
English, Spanish
M-T 8am-5pm
W 8am-6pm, Th 9am-6pm,F 8am-5pm
# DN11385 Traul Jr., Robert
NPI: 1982734257 LIC: DN11385
CERTIFICATIONS :
SAINT JOHNS COUNTY
DENTIST
#FQHC016587
Azalea Health
250 State Rd 207
Saint Augustine, FL 32084
(904) 824-3322
Special Needs: Yes
English, Spanish
M-T 8am-7pm
W-Th 8am-7pm
# DN21424 Budzinski, Volha
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 74 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1588047468 LIC: DN21424
CERTIFICATIONS :
# DN15770 Halady, Pratima
NPI: 1720256811 LIC: DN15770
CERTIFICATIONS :
# HAD56 Krotzinger, Mary
NPI: 1992796973 LIC: HAD56
CERTIFICATIONS :
# DN20873 Lopez, Melvin
NPI: 1689081242 LIC: DN20873
CERTIFICATIONS :
# DN12941 Pairot, Alfredo
NPI: 1932174448 LIC: DN12941
CERTIFICATIONS :
# DN8746 Saraga, David
NPI: 1780805028 LIC: DN8746
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#021387
Weaver & Stratton Pediatric
Dentistry & Orthodontics
112 Bartram Oaks Walk Ste #203
Saint Johns, FL 32259
(904) 264-5437
Special Needs: Yes
English, Spanish
M-T 7am-5pm
W-Th 7am-5pm
# DN19403 Weaver, James
NPI: 1023305554 LIC: DN19403
CERTIFICATIONS :
• Inhalation Sedation
SAINT LUCIE COUNTY
DENTIST
#CHC015266
DOH - Saint Lucie County Health
Department
714 Ave C
Fort Pierce, FL 34950
(772) 462-3874
Special Needs: Yes
English, Spanish, Creoles and Pidgins
(other), French
T 8am - 5pm
W-Th 8am-5pm
# DN14245 Ahmad, Haleemah*
NPI: 1437240835 LIC: DN14245
CERTIFICATIONS :
# HAD102 McKenzie, JaVon*
NPI: 1073513172 LIC: HAD102
CERTIFICATIONS :
# DN9911 Singh, Rajinder*
NPI: 1154527208 LIC: DN9911
CERTIFICATIONS :
# DN6163 Strawn, James*
NPI: 1902836851 LIC: DN6163
CERTIFICATIONS :
#FQHC020245
Florida Community Health
Centers, Inc.
1505 Delaware Ave
Fort Pierce, FL 34950
www.fchcinc.org
(772) 461-1402
Special Needs: Yes
English, Spanish, Creoles and Pidgins
(other)
M 8am - 6pm, T 8am - 8pm
W-F 8am-8pm
S 8am - 5pm
# DN20720 Blackwood, Alberto
NPI: 1487057303 LIC: DN20720
CERTIFICATIONS :
# DN13607 Morales, Carlos
NPI: 1457310559 LIC: DN13607
CERTIFICATIONS :
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN23400 Pham, Emily
NPI: 1851947568 LIC: DN23400
CERTIFICATIONS :
# DN17356 Saint Amand, Lynn
NPI: 1972655587 LIC: DN17356
CERTIFICATIONS :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
# DN13207 Zayas, Alida
NPI: 1639148968 LIC: DN13207
CERTIFICATIONS :
#014579
Happy Smiles
1100 Sw St. Lucie Blvd, Ste 206
Port Saint Lucie, FL 34986
happysmilespsl.com
(772) 807-1451
Special Needs: Yes
English, Russian, Creoles and Pidgins
English-based(other), Hebrew,
Spanish
M 10am - 5pm, T 11am - 7pm
W 9am-5pm, Th 11am-7pm,F
9am-5pm
# DN23676 Aldaya, Robair
NPI: 1508344599 LIC: DN23676
CERTIFICATIONS :
# DN23633 Andrade, Emily
NPI: 1407335409 LIC: DN23633
CERTIFICATIONS :
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
CERTIFICATIONS :
# DN17996 Etemadshahidi, Babak
NPI: 1336300805 LIC: DN17996
CERTIFICATIONS :
# DN24425 Faizzadeh, Paula
NPI: 1912550799 LIC: DN24425
CERTIFICATIONS :
# DN23511 Nguyen, Chi
NPI: 1811482656 LIC: DN23511
CERTIFICATIONS :
• Inhalation Sedation
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
# DN24429 Shahriari, Varahram
NPI: 1952954778 LIC: DN24429
CERTIFICATIONS :
# DN16481 Zadov, Marianna
NPI: 1104903301 LIC: DN16481
CERTIFICATIONS :
• Inhalation Sedation
PERIODONTICS
# DN23115 Mendoza, Juan
NPI: 1821326430 LIC: DN23115
CERTIFICATIONS :
• Inhalation Sedation
# DN11699 Simon, David
NPI: 1508303587 LIC: DN11699
CERTIFICATIONS :
• Oral / Enteral Sedation
SARASOTA COUNTY
DENTIST
#015890
Beneva Dental Care
5917 S. Beneva Road
Sarasota, FL 34238
(941) 924-2939
Special Needs: No
English, Spanish
M 1pm - 5pm, T 9am - 2pm
W 1pm-5pm, Th 9am-2pm
# DN10922 Jimenez, Baltasar
NPI: 1104031442 LIC: DN10922
CERTIFICATIONS :
• Inhalation Sedation
#FQHC019492
CenterPlace Health Inc
1750 17Th St. Building E
Sarasota, FL 34236
www.centerplacehealth.org
(941) 529-0100
Special Needs: Yes
English, Spanish
M-T 7am-4pm
W-F 7am-4pm
# DN24525 Curd, Francis
NPI: 1649395542 LIC: DN24525
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 75 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN21483 DeVilliers, Patricia
NPI: 1669568861 LIC: DN21483
CERTIFICATIONS :
• Inhalation Sedation
# DN23710 Houston, James
NPI: 1972661734 LIC: DN23710
CERTIFICATIONS :
• Inhalation Sedation
# DN14316 Jenkins, James
NPI: 1861701906 LIC: DN14316
CERTIFICATIONS :
• Inhalation Sedation
# DN16242 Misischia, William
NPI: 1619199973 LIC: DN16242
CERTIFICATIONS :
• Inhalation Sedation
#FQHC019490
CenterPlace Health Inc.
2200 Ringling Blvd
Sarasota, FL 34237
(941) 529-0200
Special Needs: No
English, Spanish
M-T 7am-5pm
W-F 7am-5pm
# DN24525 Curd, Francis*
NPI: 1649395542 LIC: DN24525
CERTIFICATIONS :
# DN21483 DeVilliers, Patricia*
NPI: 1669568861 LIC: DN21483
CERTIFICATIONS :
• Inhalation Sedation
# DN23710 Houston, James*
NPI: 1972661734 LIC: DN23710
CERTIFICATIONS :
• Inhalation Sedation
# DN14316 Jenkins, James*
NPI: 1861701906 LIC: DN14316
CERTIFICATIONS :
• Inhalation Sedation
# DN16242 Misischia, William*
NPI: 1619199973 LIC: DN16242
CERTIFICATIONS :
• Inhalation Sedation
#FQHC019491
CenterPlace Health Inc.
6950 Outreach Way
North Port, FL 34287
(941) 529-0300
Special Needs: Yes
English, Spanish
M-T 7am-4pm
W-Th 7am-4pm
# DN24525 Curd, Francis
NPI: 1649395542 LIC: DN24525
CERTIFICATIONS :
# DN21483 DeVilliers, Patricia
NPI: 1669568861 LIC: DN21483
CERTIFICATIONS :
• Inhalation Sedation
# DN23710 Houston, James
NPI: 1972661734 LIC: DN23710
CERTIFICATIONS :
• Inhalation Sedation
# DN14316 Jenkins, James
NPI: 1861701906 LIC: DN14316
CERTIFICATIONS :
• Inhalation Sedation
# DN16242 Misischia, William
NPI: 1619199973 LIC: DN16242
CERTIFICATIONS :
• Inhalation Sedation
#013443
F.A. Skordas, DDS, MS, PL
7129 Curtiss Ave, Ste #2
Sarasota, FL 34231
(941) 922-8811
Special Needs: Yes
English, Japanese
M-T 9am-5pm
W-Th 9am-5pm
S 8am - 3pm
# DN13645 Skordas, Fotios
NPI: 1124308812 LIC: DN13645
CERTIFICATIONS :
#022695
North Port Smiles
13801 Tamiami Trail, Ste B
North Port, FL 34287
(941) 200-5812
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN7845 Carlow, Anna
NPI: 1962514596 LIC: DN7845
CERTIFICATIONS :
#022617
Velasquez-Pierce Family Dentistry
Inc
1872 S. Tamiami Trail, Ste E
Venice, FL 34293
(941) 497-4997
Special Needs: Yes
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN21607 Velasquez-Pierce, Ximena
NPI: 1548606874 LIC: DN21607
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#FQHC019490
CenterPlace Health Inc.
2200 Ringling Blvd
Sarasota, FL 34237
(941) 529-0200
Special Needs: No
English, Spanish
M-T 7am-5pm
W-F 7am-5pm
# DN17050 Marcano, Zaida*
NPI: 1306815675 LIC: DN17050
CERTIFICATIONS :
• Inhalation Sedation
SEMINOLE COUNTY
DENTIST
#009751
Altamonte Mall Dental
451 Altamonte Dr Ste, 1279
Altamonte Springs, FL 32701
(407) 261-0201
Special Needs: Yes
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21079 Arnedo, Johanna
NPI: 1104213909 LIC: DN21079
CERTIFICATIONS :
• Inhalation Sedation
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN17123 Bravo, Raquel
NPI: 1538312525 LIC: DN17123
CERTIFICATIONS :
# DN21812 Cabrera, Rene
NPI: 1518313675 LIC: DN21812
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN21629 Durve, Aparna
NPI: 1437521580 LIC: DN21629
CERTIFICATIONS :
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN24375 Gaton Molina, Sarah
NPI: 1538713979 LIC: DN24375
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 76 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN24131 Krupnov, Vera
NPI: 1386202984 LIC: DN24131
CERTIFICATIONS :
# DN20101 Licina, Zeljka
NPI: 1013263292 LIC: DN20101
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
# DN15694 Luong, Timothy
NPI: 1740302629 LIC: DN15694
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
# DN23402 Montenegro, Christian
NPI: 1144714445 LIC: DN23402
CERTIFICATIONS :
# DN23652 Ospina, Luz
NPI: 1881181501 LIC: DN23652
CERTIFICATIONS :
# DN22702 Pham, Quynhnhu
NPI: 1609323948 LIC: DN22702
CERTIFICATIONS :
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
# DN22695 Toribio Fabelo, Leydy
NPI: 1033639554 LIC: DN22695
CERTIFICATIONS :
• Inhalation Sedation
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
# DN21066 Uzunova-Dimova, Kalina
NPI: 1245540947 LIC: DN21066
CERTIFICATIONS :
#012921
Amazing Smile, LLC
2417 S. French Ave
Sanford, FL 32771
(407) 321-5010
Special Needs: No
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN20701 Clemente, Evelyn
NPI: 1952715443 LIC: DN20701
CERTIFICATIONS :
#CHC10026
DOH - Seminole County Health
Department
400 W. Airport Blvd
Sanford, FL 32773
http://seminole.floridahealth.gov
(407) 665-3346
Special Needs: Yes
English, Spanish, Hindi
M-T 8am-5pm
W 8am-5pm, Th 8am-12pm,F
8am-5pm
# DN12474 Barinas, Norma
NPI: 1780690123 LIC: DN12474
CERTIFICATIONS :
# DN8976 Hanna, Nabil
NPI: 1215235924 LIC: DN8976
CERTIFICATIONS :
# HAD54 James, Frederick
NPI: 1861510984 LIC: HAD54
CERTIFICATIONS :
# DN18472 Koenig, Hans
NPI: 1760535934 LIC: DN18472
CERTIFICATIONS :
• Inhalation Sedation
#013496
Kush Dental LLC
1012 State Rd 436
Casselberry, FL 32707
(407) 636-7602
Special Needs: No
English, Spanish
M-T 8am-4pm
W 8am-4pm, Th 9am-5pm,F 9am-2pm
# DN16236 Calcagno, Manuel*
NPI: 1194866616 LIC: DN16236
CERTIFICATIONS :
# DN12237 Figaro, Mark
NPI: 1952516965 LIC: DN12237
CERTIFICATIONS :
#FQHC019164
Orange Blossom Family Health
225 N. Kennel Road
Sanford, FL 32771
(407) 428-5751
Special Needs: Yes
English, Spanish, Chinese (T),
Creoles and Pidgins
English-based(other), Hindi, Tagalog
# DN19583 Acosta, Edwin
NPI: 1578729711 LIC: DN19583
CERTIFICATIONS :
# DN19935 Keskar, Meghan
NPI: 1417205790 LIC: DN19935
CERTIFICATIONS :
# DN11833 Lim, Peter
NPI: 1821022526 LIC: DN11833
CERTIFICATIONS :
# DN23622 Pacheco, Magda
NPI: 1699264424 LIC: DN23622
CERTIFICATIONS :
#012552
Prem K. Kathuria, PA
1670 S. Hwy 17-92
Longwood, FL 32750
(407) 339-4700
Special Needs: Yes
English, Arabic, Hindi, Japanese,
Spanish
# DN8196 Kathuria, Prem*
NPI: 1336300763 LIC: DN8196
CERTIFICATIONS :
ENDODONTICS
#009751
Altamonte Mall Dental
451 Altamonte Dr Ste, 1279
Altamonte Springs, FL 32701
(407) 261-0201
Special Needs: Yes
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN13421 Gittess, Robert
NPI: 1922137058 LIC: DN13421
CERTIFICATIONS :
ORAL SURGEON
#021444
Oral & Facial Surgery of Florida,
Inc.
924 Williston Park Pt.
Lake Mary, FL 32746
(407) 624-5113
Special Needs: Yes
English
M-T 7am-4pm
W-Th 7am-4pm
# DN15621 Azizi, Abdul*
NPI: 1053329995 LIC: DN15621
CERTIFICATIONS :
• General Anesthesia
PERIODONTICS
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 77 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#009751
Altamonte Mall Dental
451 Altamonte Dr Ste, 1279
Altamonte Springs, FL 32701
(407) 261-0201
Special Needs: Yes
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN13591 Nielsen, Pamela
NPI: 1124118245 LIC: DN13591
CERTIFICATIONS :
SUMTER COUNTY
DENTIST
#015271
Central FL Dental Associates, LLC
11905 N Us Highway 301
Oxford, FL 34484
(352) 748-9688
Special Needs: Yes
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN12237 Figaro, Mark
NPI: 1952516965 LIC: DN12237
CERTIFICATIONS :
# DN13227 Johary, Carlos
NPI: 1336338755 LIC: DN13227
CERTIFICATIONS :
#FQHC10255
Langley Health Services
1389 S. U.S. Hwy 301
Sumterville, FL 33585
(352) 793-5900
Special Needs: Yes
English, Spanish
M-T 7am-6pm
W-F 7am-6pm
# DN19878 Clinton, Edna
NPI: 1376853929 LIC: DN19878
CERTIFICATIONS :
• Inhalation Sedation
# DN23356 Lutes, Meaghan
NPI: 1760974554 LIC: DN23356
CERTIFICATIONS :
# DN20142 Matthews, Irina
NPI: 1891135331 LIC: DN20142
CERTIFICATIONS :
# DN21667 Pirie, Edward
NPI: 1255705752 LIC: DN21667
CERTIFICATIONS :
# DN15250 Vavruska, Julie
NPI: 1992798649 LIC: DN15250
CERTIFICATIONS :
• Inhalation Sedation
# DN14803 Worthy, Michele
NPI: 1023196169 LIC: DN14803
CERTIFICATIONS :
• Inhalation Sedation
SUWANNEE COUNTY
DENTIST
#012194
Smile Designs
530 E Howard St
Live Oak, FL 32064
(386) 362-6800
Special Needs: Yes
English, Spanish
M 9am - 5pm,
Th-F 9am-5pm
# DN14223 Gerry, Charlotte*
NPI: 1770789455 LIC: DN14223
CERTIFICATIONS :
TAYLOR COUNTY
DENTIST
#CHC10219
DOH - Taylor County Health
Department
1215 N. Peacock Ave
Perry, FL 32347
(850) 584-5087
Special Needs: Yes
English
M-T 7am-4pm
W-Th 7am-4pm
# DTC121 Woods, Stephanie
NPI: 1962465351 LIC: DTC121
CERTIFICATIONS :
#FQHC011463
Taylor Dental Center
616 S. Jefferson St
Perry, FL 32347
http://www.northfloridamedicalcenter
s.org
(850) 223-2578
Special Needs: Yes
English
M-T 8am-5pm
W-F 8am-5pm
# DN11230 Cherkinsky, Jordan
NPI: 1184637787 LIC: DN11230
CERTIFICATIONS :
# DN24185 Durham, Dominique
NPI: 1053972257 LIC: DN24185
CERTIFICATIONS :
VOLUSIA COUNTY
DENTIST
#011119
Ballet Dental Care
1857 Providence Blvd, Ste 200
Deltona, FL 32725
(321) 283-2850
Special Needs: Yes
English, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN16520 Ballet, Lourdes
NPI: 1255517850 LIC: DN16520
CERTIFICATIONS :
#FQHC020653
Family Health Source
1205 Woodland Blvd, Ste 5
Deland, FL 32720
(386) 888-4911
Special Needs: No
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN12417 Torres, Leonel
NPI: 1942411962 LIC: DN12417
CERTIFICATIONS :
WAKULLA COUNTY
DENTIST
#CHC013453
DOH - Wakulla County Health
Department
48 Oak Street
Crawfordville, FL 32327
(850) 926-0400
Special Needs: Yes
English
M 6am - 4pm, T 7am - 4pm
W-Th 6am-4pm
# DTC121 Woods, Stephanie
NPI: 1962465351 LIC: DTC121
CERTIFICATIONS :
WALTON COUNTY
DENTIST
#012992
LECOM School of Dental
Medicine - Dental Offices
101 Lecom Way
Defuniak Springs, FL 32435
(850) 951-0200
Special Needs: Yes
English
M-T 7am-7pm
W-F 7am-7pm
# DN6824 Henry, Dan
NPI: 1932279122 LIC: DN6824
CERTIFICATIONS :
• Inhalation Sedation
# DN14491 Turner, Helen
NPI: 1518049717 LIC: DN14491
CERTIFICATIONS :
# DN6012 Zieman, Stephen
NPI: 1407100720 LIC: DN6012
CERTIFICATIONS :
#FQHC010686
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 78 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
PanCare of Florida, Inc.
479 E. Hwy 20
Freeport, FL 32439
(850) 880-6568
Special Needs: No
English
M-T 8am-5pm
W-F 8am-5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# DN23419 Lindsay, Sean
NPI: 1477046290 LIC: DN23419
CERTIFICATIONS :
# DN21740 Moffa, Michelle
NPI: 1841277407 LIC: DN21740
CERTIFICATIONS :
# DN19745 Norton, Andrew
NPI: 1861754020 LIC: DN19745
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
ENDODONTICS
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
PERIODONTICS
#012992
LECOM School of Dental
Medicine - Dental Offices
101 Lecom Way
Defuniak Springs, FL 32435
(850) 951-0200
Special Needs: Yes
English
M-T 7am-7pm
W-F 7am-7pm
# DN4547 Couch, Deck
NPI: 1417190950 LIC: DN4547
CERTIFICATIONS :
WASHINGTON COUNTY
DENTIST
#CHC015270
DOH - Washington County Health
Department
1338 South Blvd
Chipley, FL 32428
(850) 638-6240
Special Needs: Yes
English
M-T 7am-5pm
W-Th 7am-5pm
# DN18661 Whitford, Drew
NPI: 1851527303 LIC: DN18661
CERTIFICATIONS :
• Inhalation Sedation
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 79 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
FLORIDA MEDICAID ADULT
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Availability of Language Assistance Services
LIBERTY makes certain language assistance services available to you at no cost. If English is not your preferred language and you need
help communicating in your preferred language, you may call 833-276-0850 to ask what language services are available to you.
Enrollees with Disabilities
As a LIBERTY enrollee (including enrollees with disabilities), you have full and equal access to covered services as required under the
federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.
Directory Information
Did you find information that you think may need to be updated in our provider directories? Please let us know, so we can review it.
Phone: 833-276-0850 Email: providerdirectories@libertydentalplan.com
Specialist Information
Your plan may only provide benefits if you obtain a referral from your General Dentist prior to receiving treatment from a Specialist. Please
refer to your Evidence of Coverage prior to contacting a Specialist if you are unsure, or call Member Services.
In accordance with s. 1932(b)(3) of the Social Security Act
Providers may choose not to perform certain services based on religious or moral beliefs.
Requesting a current List of Providers
If you need a current listing of providers, you can find one at www.libertydentalplan.com/FLMedicaid or you may request one by calling our
Member Services Department toll-free at 833-276-0850.
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 80 of 80
June, 2020
06/15/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
