Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID CHILD

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 :

#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

#020933

Prairie Dental Center

6320 Sw 13Th St

Gainesville, FL 32608

(352) 373-3431

Special Needs: No

English, Farsi, Persian

M-T 8am-4pm

F 8am-2pm

# DN13800 Abolverdi, Shaun

NPI: 1669511598 LIC: DN13800

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

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 :

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• 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

#022671

North Central Florida Endodontics

1905 Nw 13Th Street, Ste 2

Gainesville, FL 32609

(352) 375-7776

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN5901 Goldfaden, Stephen

NPI: 1417014457 LIC: DN5901

CERTIFICATIONS :

• Inhalation Sedation

# DN23014 Natera-Fernandez,

Marianella

NPI: 1073061297 LIC: DN23014

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

# 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

ORTHODONTIST

#010955

Joseph M Waldron, DDS

611 Nw 60Th Street, Ste A

Gainesville, FL 32607

(352) 331-5622

Special Needs: No

English

M-T 8am-5pm

W-F 8am-5pm

# DN6502 Waldron, Joseph

NPI: 1063623635 LIC: DN6502

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

# DN13393 Dolce, Calogero

NPI: 1881650331 LIC: DN13393

CERTIFICATIONS :

• Board Certification

# DN15392 Donatelli, Richard

NPI: 1942387535 LIC: DN15392

CERTIFICATIONS :

# DT394 Neubert, John

NPI: 1760448989 LIC: DT394

CERTIFICATIONS :

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 :

# DTP568 Mugayar, Leda

NPI: 1043585706 LIC: DTP568

CERTIFICATIONS :

• Inhalation Sedation

# DN18234 Perez, Edna

NPI: 1962536714 LIC: DN18234

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

#011100

Millhopper Pediatric Dentistry, PL

2341 Nw 41St Street, Ste A

Gainesville, FL 32606

(352) 336-3939

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN15273 Beaufait, Nguyet

NPI: 1457380719 LIC: DN15273

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#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

# DTP437 Adewumi, Abimbola*

NPI: 1285690636 LIC: DTP437

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN22995 Connell, Christopher*

NPI: 1689125742 LIC: DN22995

CERTIFICATIONS :

• Inhalation Sedation

# DTP418 Guelmann, Marcio*

NPI: 1972568848 LIC: DTP418

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DTP267 Jerrell, Roy*

NPI: 1932159803 LIC: DTP267

CERTIFICATIONS :

# DN20915 Moore, Ronda*

NPI: 1033474176 LIC: DN20915

CERTIFICATIONS :

# DTP568 Mugayar, Leda*

NPI: 1043585706 LIC: DTP568

CERTIFICATIONS :

• Inhalation Sedation

# DN18234 Perez, Edna*

NPI: 1962536714 LIC: DN18234

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

PERIODONTICS

# 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 :

BAKER COUNTY

DENTIST

#CHC013141

DOH - Baker County Health

Department

480 W. Lowder St

Macclenny, FL 32063

baker.web@flhealth.gov

(904) 259-9815

Special Needs: Yes

M-T 8am-5pm

W-Th 8am-5pm

# DN11888 Hackney, Tara

NPI: 1710953765 LIC: DN11888

CERTIFICATIONS :

• Inhalation Sedation

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN11385 Traul Jr., Robert

NPI: 1982734257 LIC: DN11385

CERTIFICATIONS :

BAY COUNTY

DENTIST

#CHC10280

DOH - Bay County Health

Department

3518 E. 15Th St

Panama City, FL 32404

(850) 872-4455

Special Needs: Yes

English, Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN21103 Ghani, Rehan

NPI: 1316333230 LIC: DN21103

CERTIFICATIONS :

• Inhalation Sedation

# DN18413 Morshed, Aly

NPI: 1730244948 LIC: DN18413

CERTIFICATIONS :

• Inhalation Sedation

#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

# 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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#014966

Royal Dental

2335 State Ave Ste A

Panama City, FL 32405

www.royaldentalpanamacity.com

(850) 740-3100

Special Needs: Yes

English, Arabic

M-T 8am-5pm

W-Th 8am-5pm

S 8am - 1pm

# DN21597 Abdulrahim, Yahia

NPI: 1184092603 LIC: DN21597

CERTIFICATIONS :

ENDODONTICS

#018484

Hanson Endodontics

2999 W 10Th St

Panama City, FL 32401

www.hansonendo.com

(850) 215-3339

Special Needs: Yes

English

M-T 8am-4pm

W 8am-4pm,

# DN17872 Hanson, Shane

NPI: 1710907787 LIC: DN17872

CERTIFICATIONS :

• Inhalation Sedation

#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 :

ORTHODONTIST

#011426

Advanced Orthodontics

2202 State Ave, Ste 200

Panama City, FL 32405

(850) 296-8665

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W-Th 8am-5pm

# DN19214 Kovaleski, Lauren

NPI: 1366754558 LIC: DN19214

CERTIFICATIONS :

# DN10667 Wheeler, Timothy

NPI: 1558328153 LIC: DN10667

CERTIFICATIONS :

• Board Certification

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

M-T 8am-7pm

W-Th 8am-7pm

# HAD82 Alongi, Jennifer*

NPI: 1306139019 LIC: HAD82

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 4 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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 :

#012071

Magic Dental Care

6050 Babcock St Se, Ste #2

Palm Bay, FL 32909

(321) 725-9946

Special Needs: Yes

English, Arabic, Creoles and Pidgins

French-based(other), French, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 3pm

# DN15094 Assaf, Wasim

NPI: 1518048065 LIC: DN15094

CERTIFICATIONS :

• Inhalation Sedation

# DN21380 Taha, Ahmed

NPI: 1225411069 LIC: DN21380

CERTIFICATIONS :

• Inhalation Sedation

# DN21065 Vinokur, Stephanie

NPI: 1356733000 LIC: DN21065

CERTIFICATIONS :

• Inhalation Sedation

#022011

Magic Dental Care II

1325 Pine Street, Ste 103

Melbourne, FL 32901

(321) 724-4520

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 4pm

# DN15094 Assaf, Wasim

NPI: 1518048065 LIC: DN15094

CERTIFICATIONS :

• Inhalation Sedation

# DN18934 Leder, Katia

NPI: 1578669552 LIC: DN18934

CERTIFICATIONS :

• Inhalation Sedation

# DN21380 Taha, Ahmed

NPI: 1225411069 LIC: DN21380

CERTIFICATIONS :

• Inhalation Sedation

# DN21065 Vinokur, Stephanie

NPI: 1356733000 LIC: DN21065

CERTIFICATIONS :

• Inhalation Sedation

#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 :

ORAL SURGEON

#016288

Great Expressions Dental Centers

205 Palm Bay Road, Ste 159

Melbourne, FL 32904

(321) 676-4080

Special Needs: Yes

English, Russian, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 2pm

# DN22442 Turner, Mark

NPI: 1003252685 LIC: DN22442

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 5 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

PEDIATRIC DENTISTRY

#013507

Brevard Pediatric Dental

Associates - Merritt Island

2405 N Courtenay Pkwy Ste 105

Merritt Island, FL 32953

(321) 453-2450

Special Needs: Yes

English

M-T 8am-4pm

W-Th 8am-4pm

# DN11127 Milo, Scott

NPI: 1861668311 LIC: DN11127

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#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

#016288

Great Expressions Dental Centers

205 Palm Bay Road, Ste 159

Melbourne, FL 32904

(321) 676-4080

Special Needs: Yes

English, Russian, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 2pm

# DN20688 Acheampong, Emmanuel

NPI: 1407122252 LIC: DN20688

CERTIFICATIONS :

• Inhalation Sedation

#012071

Magic Dental Care

6050 Babcock St Se, Ste #2

Palm Bay, FL 32909

(321) 725-9946

Special Needs: Yes

English, Arabic, Creoles and Pidgins

French-based(other), French, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 3pm

# DN12799 Suarez, Maria

NPI: 1922015718 LIC: DN12799

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN7046 Werner, Paul

NPI: 1053325852 LIC: DN7046

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN17725 Wilson, Cindy

NPI: 1023196797 LIC: DN17725

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

#022011

Magic Dental Care II

1325 Pine Street, Ste 103

Melbourne, FL 32901

(321) 724-4520

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 4pm

# DN12799 Suarez, Maria

NPI: 1922015718 LIC: DN12799

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN7046 Werner, Paul

NPI: 1053325852 LIC: DN7046

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

BROWARD COUNTY

DENTIST

#009564

A Healthy Smile Dental

12333 Nw 18Th St. Ste 2

Pembroke Pines, FL 33026

www.ahealthysmileforlife.com

(954) 885-4224

Special Needs: No

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN17340 Delgado, Ligming

NPI: 1548396658 LIC: DN17340

CERTIFICATIONS :

#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,

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

#020859

American Dental of Florida Ft

Lauderdale

2740 E. Commercial Blvd

Fort Lauderdale, FL 33308

(954) 938-2447

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-F 8am-6pm

# DN22874 Gutierrez, Helem

NPI: 1679095905 LIC: DN22874

CERTIFICATIONS :

• Inhalation Sedation

#020858

American Dental of Florida

Margate

1605 North State Road 7 #C

Margate, FL 33063

www.smiledesigndentalfl.com

(954) 974-8550

Special Needs: Yes

English, Spanish

W 10am-6pm,

# DN22874 Gutierrez, Helem

NPI: 1679095905 LIC: DN22874

CERTIFICATIONS :

• Inhalation Sedation

#011659

American Pediatric Dental Group

10021 Pines Blvd Ste 100

Pembroke Pines, FL 33024

(954) 417-1337

Special Needs: Yes

English

M 9am - 5pm, T 8am - 5pm

W 8am-5pm, Th 9am-5pm,F 8am-5pm

S 8am - 2pm

# DN18955 Agrawal, Ankur

NPI: 1659697415 LIC: DN18955

CERTIFICATIONS :

• Inhalation Sedation

# DN19603 Frand, Joel

NPI: 1568675866 LIC: DN19603

CERTIFICATIONS :

• Inhalation Sedation

# DN21518 Mejia Valencia, Ana

NPI: 1073942629 LIC: DN21518

CERTIFICATIONS :

• Inhalation Sedation

# DN20294 Slement, Gaby

NPI: 1003244179 LIC: DN20294

CERTIFICATIONS :

• Inhalation Sedation

# DN21826 Vegas, Gabriela

NPI: 1407273881 LIC: DN21826

CERTIFICATIONS :

• Inhalation Sedation

# DN22896 Yazaji, Roula

NPI: 1669995684 LIC: DN22896

CERTIFICATIONS :

• Inhalation Sedation

#013938

American Pediatric Dental Group

Coral Springs

3353 N. University Drive

Coral Springs, FL 33065

(954) 416-0727

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18955 Agrawal, Ankur

NPI: 1659697415 LIC: DN18955

CERTIFICATIONS :

• Inhalation Sedation

# DN19603 Frand, Joel

NPI: 1568675866 LIC: DN19603

CERTIFICATIONS :

• Inhalation Sedation

# DN21518 Mejia Valencia, Ana

NPI: 1073942629 LIC: DN21518

CERTIFICATIONS :

• Inhalation Sedation

# DN20294 Slement, Gaby

NPI: 1003244179 LIC: DN20294

CERTIFICATIONS :

• Inhalation Sedation

# DN21826 Vegas, Gabriela

NPI: 1407273881 LIC: DN21826

CERTIFICATIONS :

• Inhalation Sedation

# DN22896 Yazaji, Roula

NPI: 1669995684 LIC: DN22896

CERTIFICATIONS :

• Inhalation Sedation

#017959

American Pediatric Dental Group

Plantation

12331 Sw 3Rd St, Ste 500

Plantation, FL 33325

(954) 417-1331

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18955 Agrawal, Ankur

NPI: 1659697415 LIC: DN18955

CERTIFICATIONS :

• Inhalation Sedation

# DN19603 Frand, Joel

NPI: 1568675866 LIC: DN19603

CERTIFICATIONS :

• Inhalation Sedation

# DN21518 Mejia Valencia, Ana

NPI: 1073942629 LIC: DN21518

CERTIFICATIONS :

• Inhalation Sedation

# DN20294 Slement, Gaby

NPI: 1003244179 LIC: DN20294

CERTIFICATIONS :

• Inhalation Sedation

# DN21826 Vegas, Gabriela

NPI: 1407273881 LIC: DN21826

CERTIFICATIONS :

• Inhalation Sedation

# DN22896 Yazaji, Roula

NPI: 1669995684 LIC: DN22896

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#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

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.

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

(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 :

#021831

Coral Springs Family

Orthodontics

1881 N University Drive, Ste 208

Pompano Beach, FL 33071

(954) 393-0303

Special Needs: Yes

English, Spanish

M 9am - 6pm,

W 9am-6pm,

S 9am - 1pm

# DN20537 Singh Roy, Anurupa

NPI: 1073956447 LIC: DN20537

CERTIFICATIONS :

#015482

Coral Springs Smiles Dentistry

2929 N. University Dr, Ste 203

Coral Springs, FL 33065

(954) 757-5353

Special Needs: Yes

English, Spanish, Hindi, Portuguese

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN18901 Anand, Payal

NPI: 1801088919 LIC: DN18901

CERTIFICATIONS :

#009107

Crescent Dental, PA

5522 West Sample Road

Margate, FL 33073

(954) 968-4466

Special Needs: Yes

English, Spanish

M 11am - 7pm, T 9am - 5pm

W-F 9am-5pm

# DN20557 Morel, Adalgisa

NPI: 1831339308 LIC: DN20557

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 :

#009473

Dental Excellence Corporation

7426 Wiles Road

Coral Springs, FL 33067

www.dentalexcellence.org

(954) 255-3500

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M-T 9am-5pm

W-F 9am-5pm

# DN15112 Bui, Anthony

NPI: 1568479905 LIC: DN15112

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

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#008354

Dental Partners of Weston

2721 Executive Park Drive, Ste #1

Weston, FL 33331

(954) 385-5855

Special Needs: Yes

English, Spanish

M 9am - 5pm,

W 9am-5pm,

# DN12295 Collazo, Ralph

NPI: 1720155955 LIC: DN12295

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 :

#020573

Diego Azar DMD PA

730 Riverside Drive

Coral Springs, FL 33071

(954) 575-9800

Special Needs: Yes

English, Spanish, Persian

M 9am - 7pm, T 9am - 5pm

W 9am-7pm, Th 9am-5pm,F 9am-7pm

S 9am - 2pm

# DN17121 Baghaei, Anoushirvan

NPI: 1922385640 LIC: DN17121

CERTIFICATIONS :

• Inhalation Sedation

# DN21827 Garces, Sabrina

NPI: 1811314297 LIC: DN21827

CERTIFICATIONS :

#CHC9681

DOH - Broward County Health

Department

900 N.W. 31St Ave

Fort Lauderdale, FL 33311

(954) 467-4700

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN12662 Castillo, Elzebir

NPI: 1396810883 LIC: DN12662

CERTIFICATIONS :

• Inhalation Sedation

# DN19174 Khvilivitzky, Ester

NPI: 1255633541 LIC: DN19174

CERTIFICATIONS :

# DN19750 Muller, Ingrid

NPI: 1699023549 LIC: DN19750

CERTIFICATIONS :

# DN17007 Parra-Rabeya, Patricia

NPI: 1699953422 LIC: DN17007

CERTIFICATIONS :

• Inhalation Sedation

#CHC9682

DOH - Broward County Health

Department

2421 Sw 6Th Ave

Fort Lauderdale, FL 33315

(954) 467-4705

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN12662 Castillo, Elzebir

NPI: 1396810883 LIC: DN12662

CERTIFICATIONS :

• Inhalation Sedation

# DN19174 Khvilivitzky, Ester

NPI: 1255633541 LIC: DN19174

CERTIFICATIONS :

# DN19750 Muller, Ingrid

NPI: 1699023549 LIC: DN19750

CERTIFICATIONS :

# DN17007 Parra-Rabeya, Patricia

NPI: 1699953422 LIC: DN17007

CERTIFICATIONS :

• Inhalation Sedation

#CHC9683

DOH - Broward County Health

Department

601 West Atlantic Blvd, Second Floor

Pompano Beach, FL 33060

(954) 467-4700

Special Needs: Yes

English, Spanish

T 8am - 5pm

W 8am-5pm,

# DN12662 Castillo, Elzebir

NPI: 1396810883 LIC: DN12662

CERTIFICATIONS :

• Inhalation Sedation

# DN19174 Khvilivitzky, Ester

NPI: 1255633541 LIC: DN19174

CERTIFICATIONS :

# DN19750 Muller, Ingrid

NPI: 1699023549 LIC: DN19750

CERTIFICATIONS :

# DN17007 Parra-Rabeya, Patricia

NPI: 1699953422 LIC: DN17007

CERTIFICATIONS :

• Inhalation Sedation

#CHC9684

DOH - Broward County Health

Department

4105 Pembroke Road

Hollywood, FL 33021

(954) 467-4700

Special Needs: No

English, Spanish

M 8am - 5pm,

# DN12662 Castillo, Elzebir

NPI: 1396810883 LIC: DN12662

CERTIFICATIONS :

• Inhalation Sedation

# DN19174 Khvilivitzky, Ester

NPI: 1255633541 LIC: DN19174

CERTIFICATIONS :

# DN19750 Muller, Ingrid

NPI: 1699023549 LIC: DN19750

CERTIFICATIONS :

# DN17007 Parra-Rabeya, Patricia

NPI: 1699953422 LIC: DN17007

CERTIFICATIONS :

• Inhalation Sedation

#CHC9685

DOH - Broward County Health

Department

205 N.W. 6Th Ave

Pompano Beach, FL 33060

(954) 467-4705

Special Needs: No

English

T 8am - 5pm

W 8am-5pm,

# DN12662 Castillo, Elzebir*

NPI: 1396810883 LIC: DN12662

CERTIFICATIONS :

• Inhalation Sedation

# DN19174 Khvilivitzky, Ester*

NPI: 1255633541 LIC: DN19174

CERTIFICATIONS :

# DN19750 Muller, Ingrid*

NPI: 1699023549 LIC: DN19750

CERTIFICATIONS :

# DN17007 Parra-Rabeya, Patricia*

NPI: 1699953422 LIC: DN17007

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 10 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#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 :

#006661

Dr. Michael Barnard, DDS PA &

Assoc

1209 W. Broward Blvd

Ft Lauderdale, FL 33312

www.browarddds.com

(954) 763-3358

Special Needs: Yes

French, Russian, Creoles and Pidgins

English-based(other), Serbian,

Spanish

T 7am - 5pm

W 8am-5pm, Th 7am-5pm,F 7am-6pm

# DN9973 Barnard, Michael

NPI: 1487752861 LIC: DN9973

CERTIFICATIONS :

# DN20101 Licina, Zeljka

NPI: 1013263292 LIC: DN20101

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 :

#012662

Gentle Teeth of Pembroke Pines

12251 Taft Street Ste 301

Pembroke Pines, FL 33026

www.gentleteeth.com

(954) 437-7077

Special Needs: Yes

Spanish, English

M-T 9am-7pm

W-Th 9am-7pm

S 8am - 1pm

# DN23446 Baddaloo, Reshma

NPI: 1043704026 LIC: DN23446

CERTIFICATIONS :

• Inhalation Sedation

#010848

Great Expressions Dental Centers

4660 W Hillsboro Blvd, Ste 7

Coconut Creek, FL 33073

(954) 428-1803

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Portuguese

M-T 8am-5pm

W-F 8am-5pm

S 9am - 1pm

# 058109 Gonvcalves Cordero,

Jhezanuel Carolina

NPI: 1477979557 LIC: 058109

CERTIFICATIONS :

# DN20973 Martinez, Amy

NPI: 1124382866 LIC: DN20973

CERTIFICATIONS :

# DN22938 Sanchez, Diego

NPI: 1902329816 LIC: DN22938

CERTIFICATIONS :

#010861

Great Expressions Dental Centers

2905 Sw 160Th Ave

Miramar, FL 33027

(954) 392-7051

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19020 De La Rua, Lissette

NPI: 1619297892 LIC: DN19020

CERTIFICATIONS :

# DN21238 Yanes, Marnie

NPI: 1407236052 LIC: DN21238

CERTIFICATIONS :

#010865

Great Expressions Dental Centers

140 South University Drive

Pembroke Pines, FL 33025

(954) 431-0004

Special Needs: Yes

English, Spanish, French

M-T 8am-5pm

W-F 8am-5pm

S 8am - 12pm

# DN20006 Arocha, Miguelina

NPI: 1407081540 LIC: DN20006

CERTIFICATIONS :

#010870

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Great Expressions Dental Centers

4537 Weston Road

Weston, FL 33331

(954) 349-1289

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 7am-3pm

S 8am - 12pm

# DN19020 De La Rua, Lissette

NPI: 1619297892 LIC: DN19020

CERTIFICATIONS :

# DN20339 Edwards, Laura

NPI: 1629400098 LIC: DN20339

CERTIFICATIONS :

#010987

Great Expressions Dental Centers

2365 N University Dr.

Coral Springs, FL 33065

(954) 755-1014

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-5pm

Th-F 8am-5pm

# DN20006 Arocha, Miguelina

NPI: 1407081540 LIC: DN20006

CERTIFICATIONS :

# 058109 Gonvcalves Cordero,

Jhezanuel Carolina

NPI: 1477979557 LIC: 058109

CERTIFICATIONS :

#016226

Great Expressions Dental Centers

9601 W. Atlantic Blvd

Coral Springs, FL 33071

(954) 753-7400

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

S 9am - 1pm

# DN21396 Dagan, Shachar

NPI: 1447632542 LIC: DN21396

CERTIFICATIONS :

#017850

Great Smiles Dental of Fort

Lauderdale

2633 E. Commercial Blvd Ste B

Fort Lauderdale, FL 33308

(954) 530-5352

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 1pm

# DN19482 Murcia, Marcela

NPI: 1588952261 LIC: DN19482

CERTIFICATIONS :

#016656

Greenberg Dental & Orthodontics

1739 Commercial Blvd

Fort Lauderdale, FL 33334

(954) 368-9891

Special Needs: Yes

English, Spanish

M 11am - 7pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

# 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 :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#016725

Greenberg Dental & Orthodontics

7165 W. Oakland Park Blvd

Lauderhill, FL 33313

(954) 289-2393

Special Needs: Yes

Spanish

M-T 7am-3pm

W-Th 10am-6pm

# 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 :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN17455 Stein, Stacy

NPI: 1467637561 LIC: DN17455

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#017045

Greenberg Dental & Orthodontics

6821 Taft Street

Hollywood, FL 33024

(954) 399-3826

Special Needs: Yes

English, Spanish

M 11am - 7pm, T 8am - 4pm

W-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 :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN23796 Lajevardi, Navid

NPI: 1194212472 LIC: DN23796

CERTIFICATIONS :

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

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 12 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN24103 Neyra, Arlet*

NPI: 1730747833 LIC: DN24103

CERTIFICATIONS :

# DN22692 Nguyen, Josie*

NPI: 1548790801 LIC: DN22692

CERTIFICATIONS :

• Inhalation Sedation

• Oral / Enteral Sedation

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN23069 Piccione, Francesco

NPI: 1295274835 LIC: DN23069

CERTIFICATIONS :

# DN22932 Rincon, Karolina

NPI: 1790293595 LIC: DN22932

CERTIFICATIONS :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN17455 Stein, Stacy

NPI: 1467637561 LIC: DN17455

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#017408

Greenberg Dental & Orthodontics

5443 W. Atlantic Blvd

Margate, FL 33063

(954) 947-8765

Special Needs: Yes

English, Spanish

M 11am - 7pm, T 7am - 3pm

Th-F 7am-3pm

# 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 :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN17455 Stein, Stacy

NPI: 1467637561 LIC: DN17455

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#017046

Greenberg Dental & Orthodontics,

8688 Griffin Road

Fort Lauderdale, FL 33328

(954) 399-7814

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-Th 9am-5pm

# 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 :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN23796 Lajevardi, Navid

NPI: 1194212472 LIC: DN23796

CERTIFICATIONS :

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN24103 Neyra, Arlet*

NPI: 1730747833 LIC: DN24103

CERTIFICATIONS :

# DN22692 Nguyen, Josie*

NPI: 1548790801 LIC: DN22692

CERTIFICATIONS :

• Inhalation Sedation

• Oral / Enteral Sedation

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN23069 Piccione, Francesco

NPI: 1295274835 LIC: DN23069

CERTIFICATIONS :

# DN22932 Rincon, Karolina

NPI: 1790293595 LIC: DN22932

CERTIFICATIONS :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN17455 Stein, Stacy

NPI: 1467637561 LIC: DN17455

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#021445

James Kerns DMD PLLC

6905 W. Broward Blvd. Ste 101

Plantation, FL 33317

smiledesigndentalpl.com

(954) 641-0414

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN22304 Kesman, Paola

NPI: 1508313578 LIC: DN22304

CERTIFICATIONS :

#016763

Jennifer Garcia DDS

3501 Nw 84Th Ave

Sunrise, FL 33351

(954) 741-2323

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-1pm

# DN21347 Garcia-Avalo, Jennifer

NPI: 1972985257 LIC: DN21347

CERTIFICATIONS :

• Inhalation Sedation

#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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1285693267 LIC: DN14451

CERTIFICATIONS :

#012912

Juan Carlos Flores DMD

5644 W. Atlantic Blvd

Margate, FL 33063

(954) 971-6115

Special Needs: Yes

English, Spanish

T 9am - 5pm

# DN17732 Flores, Juan*

NPI: 1548459803 LIC: DN17732

CERTIFICATIONS :

#016230

Kid's Dental Place

333 Nw 70Th Ave #101

Plantation, FL 33317

kidsdentalfl.com

(954) 472-3118

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Portuguese

M-T 8am-6pm

W-F 8am-6pm

S 8am - 1pm

# DN20926 Woodruff, Joshua

NPI: 1013331644 LIC: DN20926

CERTIFICATIONS :

#020216

Kids Healthy Smiles

2722 Ne 1St Street, Ste 1

Pompano Beach, FL 33062

www.kidshealthysmiles.com

(954) 590-8454

Special Needs: Yes

English, Spanish, French, Portuguese

M-T 8am-5pm

Th-F 8am-5pm

S 9am - 2pm

# DN21446 Granada-Ramirez, Erika

NPI: 1134503329 LIC: DN21446

CERTIFICATIONS :

• Inhalation Sedation

# DN19419 Tchou, Luisa

NPI: 1124315270 LIC: DN19419

CERTIFICATIONS :

• Inhalation Sedation

#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 :

#021614

Lauderdale Dentistry For Kids

LLC

4500 N State Road 7, Ste 101

Fort Lauderdale, FL 33319

(954) 261-7551

Special Needs: Yes

English, Spanish

M 8am - 6pm, T 9am - 6pm

W 8am-6pm, Th 10am-7pm,F

8am-2pm

# DN20549 Haghighi, Azin

NPI: 1730512781 LIC: DN20549

CERTIFICATIONS :

• Inhalation Sedation

# DN21007 Tijerino, David

NPI: 1538397492 LIC: DN21007

CERTIFICATIONS :

• Inhalation Sedation

#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 :

#016573

Mini Mouths Dentistry

700 N. Hiatus Rd Ste 101

Pembroke Pines, FL 33026

www.minimouths.com

(754) 217-4633

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-F 8am-5pm

# DN20969 Agudelo, Monica

NPI: 1578961751 LIC: DN20969

CERTIFICATIONS :

# DN21446 Granada-Ramirez, Erika

NPI: 1134503329 LIC: DN21446

CERTIFICATIONS :

• Inhalation Sedation

# DN20557 Morel, Adalgisa

NPI: 1831339308 LIC: DN20557

CERTIFICATIONS :

# DN24076 Savioli, Cynthia

NPI: 1336677756 LIC: DN24076

CERTIFICATIONS :

#016172

Mini Mouths Dentistry for

Children

5481 N. University Dr Ste 102

Coral Springs, FL 33067

(954) 575-5488

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-Th 8am-5pm

# DN20969 Agudelo, Monica

NPI: 1578961751 LIC: DN20969

CERTIFICATIONS :

# DN21446 Granada-Ramirez, Erika

NPI: 1134503329 LIC: DN21446

CERTIFICATIONS :

• Inhalation Sedation

# DN20557 Morel, Adalgisa

NPI: 1831339308 LIC: DN20557

CERTIFICATIONS :

# DN24076 Savioli, Cynthia

NPI: 1336677756 LIC: DN24076

CERTIFICATIONS :

# DN19419 Tchou, Luisa

NPI: 1124315270 LIC: DN19419

CERTIFICATIONS :

• Inhalation Sedation

#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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#007926

Pediatric Dental Centers of

Broward

8351 W. Atlantic Blvd

Coral Springs, FL 33071

(954) 341-0002

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 2pm

# DN17647 Bueno, Rosa

NPI: 1972649218 LIC: DN17647

CERTIFICATIONS :

• Inhalation Sedation

# DN12873 Cerrud, Ginette

NPI: 1720093412 LIC: DN12873

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 :

#008290

Pines Dental Associates

1541 North Palm Ave

Pembroke Pines, FL 33026

www.pinesdental.com

(954) 432-6133

Special Needs: Yes

English, Spanish

M 11am - 6pm, T 9am - 5pm

W-Th 9am-5pm

# DN13520 Mendez, Antonio

NPI: 1659570430 LIC: DN13520

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

#015503

Premier Dental Center II

2472 N. University Dr

Pembroke Pines, FL 33024

(954) 544-5132

Special Needs: No

English, Spanish, Vietnamese

M-T 8am-5pm

W-F 8am-5pm

# DN15460 Nguyen, Binh

NPI: 1427153410 LIC: DN15460

CERTIFICATIONS :

#015501

Premier Dental Center PA

7160 Pembroke Rd

Miramar, FL 33023

(954) 987-6977

Special Needs: No

English, Spanish, Vietnamese

M-T 8am-5pm

W-Th 8am-5pm

# DN22902 Herschdorfer, Tania

NPI: 1669994125 LIC: DN22902

CERTIFICATIONS :

# DN15460 Nguyen, Binh

NPI: 1427153410 LIC: DN15460

CERTIFICATIONS :

#020351

R & F Dental Clinic, PA

6917 Miramar Parkway

Miramar, FL 33023

(954) 986-9351

Special Needs: Yes

English, Spanish

M 9am - 6pm, T 9am - 7pm

W-Th 9am-6pm

# DN12945 Perello, Rosanna

NPI: 1134280258 LIC: DN12945

CERTIFICATIONS :

#011252

Sage Dental Group of Ft

Lauderdale

6171 N. Federal Hwy

Fort Lauderdale, FL 33308

(954) 641-5610

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19079 Fernandez-Martinez,

Mariangel

NPI: 1376857441 LIC: DN19079

CERTIFICATIONS :

# DN20549 Haghighi, Azin

NPI: 1730512781 LIC: DN20549

CERTIFICATIONS :

• Inhalation Sedation

# 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 :

#014300

Sage Dental of Tamarac

5779 N. University Dr

Tamarac, FL 33321

(954) 580-4848

Special Needs: No

English, Spanish

M-T 8am-5pm

Th-F 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 15 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN19079 Fernandez-Martinez,

Mariangel

NPI: 1376857441 LIC: DN19079

CERTIFICATIONS :

# DN20549 Haghighi, Azin

NPI: 1730512781 LIC: DN20549

CERTIFICATIONS :

• Inhalation Sedation

# 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 :

#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

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 :

#020914

Smile Design Of Hallandale

Beach LLC

2100 E Hallandale Beach Blvd, Ste

305

Hallandale Beach, FL 33009

(954) 454-4949

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN19577 Green, Dory

NPI: 1538459409 LIC: DN19577

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 16 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#006658

Smile Garden Inc

6880 Taft Street

Hollywood, FL 33024

(954) 987-4141

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

# DN15750 Tendero, Alyne

NPI: 1578670907 LIC: DN15750

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

W-Th 8am-4pm

# DN7410 Rothenberg, Stephen

NPI: 1083802052 LIC: DN7410

CERTIFICATIONS :

#007669

Sunrise Dental Services, PLLC

6765 Sunset Strip, Ste 3

Sunrise, FL 33313

(954) 572-1500

Special Needs: No

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-3pm

W-Th 8am-3pm

# DN16198 Orpahnos, Nancy

NPI: 1497893028 LIC: DN16198

CERTIFICATIONS :

#007578

Sunshine Dental

1711 Hammondville Road

Pompano Beach, FL 33069

(954) 972-6066

Special Needs: Yes

English, Spanish, Portuguese

M-T 9am-5pm

W-Th 9am-5pm

S 8am - 1pm

# DN16118 Acosta-Ortiz, Rodolfo

NPI: 1689782435 LIC: DN16118

CERTIFICATIONS :

#007587

Sunshine Dental Care of

Lauderhill

2331 North State Road 7, Ste 109

Lauderhill, FL 33313

(954) 486-6989

Special Needs: Yes

English, Spanish

T 9am - 5pm

# DN16118 Acosta-Ortiz, Rodolfo

NPI: 1689782435 LIC: DN16118

CERTIFICATIONS :

#007870

Super Smiles Pediatric Dentistry

& Orthodontics

815 S. University Dr. Ste #100

Plantation, FL 33324

(954) 473-6900

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other), Portuguese

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN20926 Woodruff, Joshua

NPI: 1013331644 LIC: DN20926

CERTIFICATIONS :

#017011

Super Smiles Pediatric Dentistry

& Orthodontics

1670 N. University Dr Ste B

Coral Springs, FL 33071

(954) 346-8108

Special Needs: Yes

English, Spanish, French

M-T 8am-5pm

W-F 8am-5pm

# DN20926 Woodruff, Joshua

NPI: 1013331644 LIC: DN20926

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 :

#020457

Vital Dental Center

279 S. State Road 7

Margate, FL 33068

www.vitaldentalcenter.com

(954) 975-9779

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M 9am - 6pm, T 9am - 5pm

W 10am-5pm, Th 11am-7pm,F

9am-5pm

S 9am - 4pm

# DN20090 Maya, Martin

NPI: 1790046233 LIC: DN20090

CERTIFICATIONS :

# DN14801 Williams, Keith

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1629296793 LIC: DN14801

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 :

#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

# DN15585 Posner, William

NPI: 1730203100 LIC: DN15585

CERTIFICATIONS :

#010861

Great Expressions Dental Centers

2905 Sw 160Th Ave

Miramar, FL 33027

(954) 392-7051

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19592 Mattos, Katia

NPI: 1003173386 LIC: DN19592

CERTIFICATIONS :

#010987

Great Expressions Dental Centers

2365 N University Dr.

Coral Springs, FL 33065

(954) 755-1014

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-5pm

Th-F 8am-5pm

# DN21531 Marschall, Annika

NPI: 1528370798 LIC: DN21531

CERTIFICATIONS :

# DN19592 Mattos, Katia

NPI: 1003173386 LIC: DN19592

CERTIFICATIONS :

# DN14230 Zeim, Jason

NPI: 1760498422 LIC: DN14230

CERTIFICATIONS :

#016226

Great Expressions Dental Centers

9601 W. Atlantic Blvd

Coral Springs, FL 33071

(954) 753-7400

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

S 9am - 1pm

# DN19592 Mattos, Katia

NPI: 1003173386 LIC: DN19592

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 :

#009139

Pembroke Dental Associates

12251 Taft St, Ste 404

Pembroke Pines, FL 33026

(954) 432-7077

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN11671 Porras, Edgar

NPI: 1659467785 LIC: DN11671

CERTIFICATIONS :

#010649

Plantation Dental Services, P.A.

314 S. University Drive

Plantation, FL 33324

(954) 474-8475

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN8490 Comora, Robert

NPI: 1699855361 LIC: DN8490

CERTIFICATIONS :

# DN18596 Selman, Anas

NPI: 1134354491 LIC: DN18596

CERTIFICATIONS :

#011252

Sage Dental Group of Ft

Lauderdale

6171 N. Federal Hwy

Fort Lauderdale, FL 33308

(954) 641-5610

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN20550 Gankin, Mikhail

NPI: 1114112935 LIC: DN20550

CERTIFICATIONS :

#014300

Sage Dental of Tamarac

5779 N. University Dr

Tamarac, FL 33321

(954) 580-4848

Special Needs: No

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

# DN20550 Gankin, Mikhail

NPI: 1114112935 LIC: DN20550

CERTIFICATIONS :

#006581

Sawgrass Mills Mall Dental

12801 W. Sunrise Blvd, Ste F222

Sunrise, FL 33323

(954) 846-7171

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#010648

Sunrise Center for Dental

Specialties

1776 North Pine Island Road, Ste 300

Plantation, FL 33322

(954) 916-9955

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN8490 Comora, Robert

NPI: 1699855361 LIC: DN8490

CERTIFICATIONS :

# DN22214 Sarmiento, Jeffrey

NPI: 1184177560 LIC: DN22214

CERTIFICATIONS :

ORAL SURGEON

#010848

Great Expressions Dental Centers

4660 W Hillsboro Blvd, Ste 7

Coconut Creek, FL 33073

(954) 428-1803

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Portuguese

M-T 8am-5pm

W-F 8am-5pm

S 9am - 1pm

# DN12418 Torres, Luis

NPI: 1801977582 LIC: DN12418

CERTIFICATIONS :

• General Anesthesia

#010861

Great Expressions Dental Centers

2905 Sw 160Th Ave

Miramar, FL 33027

(954) 392-7051

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN12418 Torres, Luis

NPI: 1801977582 LIC: DN12418

CERTIFICATIONS :

• General Anesthesia

#010865

Great Expressions Dental Centers

140 South University Drive

Pembroke Pines, FL 33025

(954) 431-0004

Special Needs: Yes

English, Spanish, French

M-T 8am-5pm

W-F 8am-5pm

S 8am - 12pm

# DN12418 Torres, Luis

NPI: 1801977582 LIC: DN12418

CERTIFICATIONS :

• General Anesthesia

#016226

Great Expressions Dental Centers

9601 W. Atlantic Blvd

Coral Springs, FL 33071

(954) 753-7400

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

S 9am - 1pm

# DN22442 Turner, Mark

NPI: 1003252685 LIC: DN22442

CERTIFICATIONS :

• Inhalation Sedation

#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

#010649

Plantation Dental Services, P.A.

314 S. University Drive

Plantation, FL 33324

(954) 474-8475

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16630 Patel, Nishul

NPI: 1952558439 LIC: DN16630

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#010648

Sunrise Center for Dental

Specialties

1776 North Pine Island Road, Ste 300

Plantation, FL 33322

(954) 916-9955

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN18521 Grider, Joseph

NPI: 1881895910 LIC: DN18521

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN20155 Oppenheimer, Eli

NPI: 1174866339 LIC: DN20155

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#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

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

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

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#015849

Castaneda Orthodontics

5558 S. Flamingo Rd, Ste 43

Cooper City, FL 33330

castanedaorthodontics.com

(954) 434-3043

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 4pm

W 10am-6pm, Th 7am-4pm

# DN19707 Castaneda-Medina,

Zulma

NPI: 1710234463 LIC: DN19707

CERTIFICATIONS :

#019202

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Cooper Orthodontics

4570 Lyons Road

Coconut Creek, FL 33073

(954) 977-9477

Special Needs: Yes

English, Spanish

M 8am - 5pm,

F 8am-2pm

# DN18379 Cooper, Andrew

NPI: 1710206149 LIC: DN18379

CERTIFICATIONS :

# DN20037 Cooper, Justin

NPI: 1245519768 LIC: DN20037

CERTIFICATIONS :

# DN20383 Fernandez-Feo, Carlos

NPI: 1417383092 LIC: DN20383

CERTIFICATIONS :

# DN21521 Lieberman, Ian

NPI: 1497265045 LIC: DN21521

CERTIFICATIONS :

# DN21859 Loebl, Daniela

NPI: 1457822371 LIC: DN21859

CERTIFICATIONS :

# DN20300 Matamoros, Marcela

NPI: 1417311846 LIC: DN20300

CERTIFICATIONS :

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

CERTIFICATIONS :

#019204

Cooper Orthodontics

700 N. Hiatus Road, Ste 101

Pembroke Pines, FL 33026

(954) 973-5725

Special Needs: Yes

English, Spanish

T 8am - 5pm

W 8am-5pm,

# DN18379 Cooper, Andrew

NPI: 1710206149 LIC: DN18379

CERTIFICATIONS :

# DN20037 Cooper, Justin

NPI: 1245519768 LIC: DN20037

CERTIFICATIONS :

# DN20383 Fernandez-Feo, Carlos

NPI: 1417383092 LIC: DN20383

CERTIFICATIONS :

# DN21521 Lieberman, Ian

NPI: 1497265045 LIC: DN21521

CERTIFICATIONS :

# DN21859 Loebl, Daniela

NPI: 1457822371 LIC: DN21859

CERTIFICATIONS :

# DN20300 Matamoros, Marcela

NPI: 1417311846 LIC: DN20300

CERTIFICATIONS :

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

CERTIFICATIONS :

#008999

Dr. Laurie Gittess

1625 North Commerce Parkway Ste

317

Weston, FL 33326

www.westonorthodontics.com

(954) 389-2345

Special Needs: Yes

English, Spanish

M 9am - 6pm, T 9am - 5pm

W 9am-6pm, Th 8am-5pm,F 9am-3pm

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

#EV263646

Hollywood Orthodontics

3113 Stirling Road Ste 101

Fort Lauderdale, FL 33312

(954) 981-5333

Special Needs: Yes

English, Spanish

M-T 8am-6pm

F 8am-2pm

# DN15528 Nicieza, Fausto

NPI: 1952418360 LIC: DN15528

CERTIFICATIONS :

#021614

Lauderdale Dentistry For Kids

LLC

4500 N State Road 7, Ste 101

Fort Lauderdale, FL 33319

(954) 261-7551

Special Needs: Yes

English, Spanish

M 8am - 6pm, T 9am - 6pm

W 8am-6pm, Th 10am-7pm,F

8am-2pm

# DN13470 Ramos, Gisleda

NPI: 1437204765 LIC: DN13470

CERTIFICATIONS :

#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 :

#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

# DTP600 Contasti-Bocco, Gisela

NPI: 1871903914 LIC: DTP600

CERTIFICATIONS :

# DN16470 Vargas, Jorge

NPI: 1154419349 LIC: DN16470

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 :

#007926

Pediatric Dental Centers of

Broward

8351 W. Atlantic Blvd

Coral Springs, FL 33071

(954) 341-0002

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 2pm

# DN13470 Ramos, Gisleda

NPI: 1437204765 LIC: DN13470

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

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#014372

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Sawgrass Orthodontics LLC

175 Nw 136Th Ave

Sunrise, FL 33325

www.sawgrassortho.com

(954) 514-2111

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

# DN16748 Igualada-Heine, Kristen*

NPI: 1326235110 LIC: DN16748

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 :

#006658

Smile Garden Inc

6880 Taft Street

Hollywood, FL 33024

(954) 987-4141

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

# DN15528 Nicieza, Fausto

NPI: 1952418360 LIC: DN15528

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#013763

A & B Pediatric Dentists

6370 N. State Rd 7 Ste 115

Coconut Creek, FL 33073

(954) 866-4223

Special Needs: Yes

English, Spanish, Portuguese

M 8am - 5pm, T 9am - 5pm

W 9am-5pm, Th 8am-5pm,F 9am-1pm

# DN19224 Aguilar, Liza

NPI: 1932404027 LIC: DN19224

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN18845 Barba, Erica

NPI: 1013043710 LIC: DN18845

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

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

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

CERTIFICATIONS :

• Inhalation Sedation

#020859

American Dental of Florida Ft

Lauderdale

2740 E. Commercial Blvd

Fort Lauderdale, FL 33308

(954) 938-2447

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-F 8am-6pm

# DN21814 Criscuolo, Stephen

NPI: 1053792168 LIC: DN21814

CERTIFICATIONS :

• Inhalation Sedation

#011659

American Pediatric Dental Group

10021 Pines Blvd Ste 100

Pembroke Pines, FL 33024

(954) 417-1337

Special Needs: Yes

English

M 9am - 5pm, T 8am - 5pm

W 8am-5pm, Th 9am-5pm,F 8am-5pm

S 8am - 2pm

# DN18730 Aza, Sara

NPI: 1386872521 LIC: DN18730

CERTIFICATIONS :

• Inhalation Sedation

# DN24237 Chardon, Yohayra

NPI: 1689063133 LIC: DN24237

CERTIFICATIONS :

# DN22409 Erazo, Nicole

NPI: 1760839278 LIC: DN22409

CERTIFICATIONS :

• Inhalation Sedation

# DN23165 Garber, Yamila

NPI: 1013376318 LIC: DN23165

CERTIFICATIONS :

# DN19743 Liou, Shasan

NPI: 1770848731 LIC: DN19743

CERTIFICATIONS :

• Inhalation Sedation

# DN18474 McCallum, Tamara

NPI: 1366607236 LIC: DN18474

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN23990 Nolte, Samantha

NPI: 1114342797 LIC: DN23990

CERTIFICATIONS :

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN17608 Pena, William

NPI: 1922246388 LIC: DN17608

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18321 Valiente, Lizette

NPI: 1851547863 LIC: DN18321

CERTIFICATIONS :

• Inhalation Sedation

#013938

American Pediatric Dental Group

Coral Springs

3353 N. University Drive

Coral Springs, FL 33065

(954) 416-0727

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18730 Aza, Sara

NPI: 1386872521 LIC: DN18730

CERTIFICATIONS :

• Inhalation Sedation

# DN24237 Chardon, Yohayra

NPI: 1689063133 LIC: DN24237

CERTIFICATIONS :

# DN22409 Erazo, Nicole

NPI: 1760839278 LIC: DN22409

CERTIFICATIONS :

• Inhalation Sedation

# DN23165 Garber, Yamila

NPI: 1013376318 LIC: DN23165

CERTIFICATIONS :

# DN19743 Liou, Shasan

NPI: 1770848731 LIC: DN19743

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 21 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN18474 McCallum, Tamara

NPI: 1366607236 LIC: DN18474

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN23990 Nolte, Samantha

NPI: 1114342797 LIC: DN23990

CERTIFICATIONS :

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN17608 Pena, William

NPI: 1922246388 LIC: DN17608

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18321 Valiente, Lizette

NPI: 1851547863 LIC: DN18321

CERTIFICATIONS :

• Inhalation Sedation

#017959

American Pediatric Dental Group

Plantation

12331 Sw 3Rd St, Ste 500

Plantation, FL 33325

(954) 417-1331

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18730 Aza, Sara

NPI: 1386872521 LIC: DN18730

CERTIFICATIONS :

• Inhalation Sedation

# DN24237 Chardon, Yohayra

NPI: 1689063133 LIC: DN24237

CERTIFICATIONS :

# DN22409 Erazo, Nicole

NPI: 1760839278 LIC: DN22409

CERTIFICATIONS :

• Inhalation Sedation

# DN23165 Garber, Yamila

NPI: 1013376318 LIC: DN23165

CERTIFICATIONS :

# DN19743 Liou, Shasan

NPI: 1770848731 LIC: DN19743

CERTIFICATIONS :

• Inhalation Sedation

# DN18474 McCallum, Tamara

NPI: 1366607236 LIC: DN18474

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN23990 Nolte, Samantha

NPI: 1114342797 LIC: DN23990

CERTIFICATIONS :

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN17608 Pena, William

NPI: 1922246388 LIC: DN17608

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18321 Valiente, Lizette

NPI: 1851547863 LIC: DN18321

CERTIFICATIONS :

• Inhalation Sedation

#017023

Baitner Pediatric Dentistry

4480 Sheridan St

Hollywood, FL 33021

(754) 263-2433

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), Hebrew

T 8am - 5pm

W-Th 8am-5pm

# DN18721 Baitner, Jessica

NPI: 1639331846 LIC: DN18721

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

#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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#007565

Cassia Barros DDS PA

824 Se 8Th Ave

Deerfield Beach, FL 33441

(954) 532-9938

Special Needs: Yes

English, Spanish, Portuguese

M-T 9am-5pm

W-Th 9am-5pm

# DN16522 Barros, Cassia

NPI: 1417037706 LIC: DN16522

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#016028

Coral Springs Dental Center

1700 N. University Dr. Ste 101

Coral Springs, FL 33071

(954) 344-8800

Special Needs: Yes

English, Spanish

M-T 8am-8pm

W 8am-8pm, Th 9am-8pm,F 8am-5pm

S 8am - 2pm, Su 8am - 5pm

# DN21814 Criscuolo, Stephen

NPI: 1053792168 LIC: DN21814

CERTIFICATIONS :

• Inhalation Sedation

#021449

Cosmic Smiles Pediatric Dentistry

3027 E. Commercial Blvd.

Fort Lauderdale, FL 33308

www.cosmicsmiles.com

(954) 246-4777

Special Needs: Yes

English, Russian, Spanish

M 8am - 7pm,

Th-F 8am-7pm

S 8am - 2pm

# 055596 Berlin, Julian

NPI: 1568774719 LIC: 055596

CERTIFICATIONS :

• Inhalation Sedation

• Oral / Enteral Sedation

#009286

Frederic G. Kirsch, D.D.S.

1881 N. University Drive, Ste 201

Coral Springs, FL 33071

delfandentistry.com

(954) 753-7770

Special Needs: Yes

Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-5pm

W 8am-5pm, Th 8am-12pm

S 8am - 12pm

# DN6027 Kirsch, Frederic

NPI: 1235279050 LIC: DN6027

CERTIFICATIONS :

#010848

Great Expressions Dental Centers

4660 W Hillsboro Blvd, Ste 7

Coconut Creek, FL 33073

(954) 428-1803

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Portuguese

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 22 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W-F 8am-5pm

S 9am - 1pm

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#010861

Great Expressions Dental Centers

2905 Sw 160Th Ave

Miramar, FL 33027

(954) 392-7051

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN20210 Abarca, Marvin

NPI: 1316388820 LIC: DN20210

CERTIFICATIONS :

• Inhalation Sedation

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

CERTIFICATIONS :

• Inhalation Sedation

#010865

Great Expressions Dental Centers

140 South University Drive

Pembroke Pines, FL 33025

(954) 431-0004

Special Needs: Yes

English, Spanish, French

M-T 8am-5pm

W-F 8am-5pm

S 8am - 12pm

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#010870

Great Expressions Dental Centers

4537 Weston Road

Weston, FL 33331

(954) 349-1289

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 7am-3pm

S 8am - 12pm

# DN20210 Abarca, Marvin

NPI: 1316388820 LIC: DN20210

CERTIFICATIONS :

• Inhalation Sedation

#016226

Great Expressions Dental Centers

9601 W. Atlantic Blvd

Coral Springs, FL 33071

(954) 753-7400

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

S 9am - 1pm

# DN20210 Abarca, Marvin

NPI: 1316388820 LIC: DN20210

CERTIFICATIONS :

• Inhalation Sedation

# DN17836 Smith, Christina

NPI: 1104963149 LIC: DN17836

CERTIFICATIONS :

• Inhalation Sedation

#EV264255

Hart to Hart Dental

3425 N Dixie Hwy

Oakland Park, FL 33334

(954) 376-3676

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN22285 Hart, Kelly

NPI: 1891285375 LIC: DN22285

CERTIFICATIONS :

#022886

Izzy Kidz Dentistry

2323 Ne 26Th Ave, Ste 107

Pompano Beach, FL 33062

(954) 406-8800

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN23119 Noskow, Yisroel

NPI: 1922549054 LIC: DN23119

CERTIFICATIONS :

#014019

Jacaranda Smiles

10051 Pines Blvd Ste D

Pembroke Pines, FL 33024

(954) 251-2717

Special Needs: Yes

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

S 8am - 12pm

# DN18735 Landa, Rene

NPI: 1215166368 LIC: DN18735

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN23119 Noskow, Yisroel

NPI: 1922549054 LIC: DN23119

CERTIFICATIONS :

#021123

Jacaranda Smiles Plantation

104 Nw 100Th Ave, Ste 104

Plantation, FL 33324

(954) 452-9988

Special Needs: Yes

English, Spanish

M 7am - 5pm, T 8am - 6pm

W 7am-7pm, Th 8am-6pm,F 7am-5pm

# DN18735 Landa, Rene

NPI: 1215166368 LIC: DN18735

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN23119 Noskow, Yisroel

NPI: 1922549054 LIC: DN23119

CERTIFICATIONS :

#017003

Jacaranda Smiles West

18503 Pines Blvd. Ste 209

Pembroke Pines, FL 33029

jacarandasmiles.com

(954) 436-0502

Special Needs: Yes

English, Spanish

M 7am - 5pm, T 8am - 5pm

W-F 8am-5pm

S 8am - 12pm

# DN18735 Landa, Rene

NPI: 1215166368 LIC: DN18735

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN23119 Noskow, Yisroel

NPI: 1922549054 LIC: DN23119

CERTIFICATIONS :

#021445

James Kerns DMD PLLC

6905 W. Broward Blvd. Ste 101

Plantation, FL 33317

smiledesigndentalpl.com

(954) 641-0414

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN21814 Criscuolo, Stephen

NPI: 1053792168 LIC: DN21814

CERTIFICATIONS :

• Inhalation Sedation

#010179

Journey Kids Dental

2022 Ne 18Th Street

Ft Lauderdale, FL 33305

(954) 727-9865

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 23 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

M-T 9am-5pm

W-F 9am-5pm

# DN18784 Olivera, Marisabel

NPI: 1750674891 LIC: DN18784

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN20703 Romero, Alejandra

NPI: 1316310303 LIC: DN20703

CERTIFICATIONS :

• Inhalation Sedation

#021752

Junior Smiles

8223 W. Atlantic Blvd, Ste B

Coral Springs, FL 33071

(954) 300-3002

Special Needs: Yes

English, Spanish

S 8am - 5pm

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

CERTIFICATIONS :

• Inhalation Sedation

#010675

Kids Care Dental and

Orthodontics

10794 Pines Blvd, Ste 101

Pembroke Pines, FL 33026

(954) 432-1607

Special Needs: Yes

English, Spanish

M 8am - 5pm,

S 8am - 1pm

# DN14446 Grandison, Nigel

NPI: 1326148909 LIC: DN14446

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010676

Kids Care Dental and

Orthodontics

10117 Cleary Blvd

Plantation, FL 33324

(954) 916-9060

Special Needs: Yes

English, Spanish

T 8am - 5pm

W-F 8am-5pm

S 8am - 2pm

# DN14446 Grandison, Nigel

NPI: 1326148909 LIC: DN14446

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#015484

Kids Dental Now

2500 E. Hallandale Beach Blvd. Ste M

Hallandale, FL 33009

(954) 951-3001

Special Needs: Yes

Creoles and Pidgins

French-based(other), English,

Romanian, Russian, Spanish

M-T 10am-5pm

W 10am-5pm,

# DN20501 Cabel, Anamaria

NPI: 1366869331 LIC: DN20501

CERTIFICATIONS :

• Inhalation Sedation

#016230

Kid's Dental Place

333 Nw 70Th Ave #101

Plantation, FL 33317

kidsdentalfl.com

(954) 472-3118

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Portuguese

M-T 8am-6pm

W-F 8am-6pm

S 8am - 1pm

# DN20401 Buscemi, Amanda*

NPI: 1669808572 LIC: DN20401

CERTIFICATIONS :

• Inhalation Sedation

# DN21064 Storch, Dana*

NPI: 1801219563 LIC: DN21064

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#022779

Luv Pediatric Dentistry

10071 Sunset Strip

Fort Lauderdale, FL 33322

Luvpediatricdentistry.com

(954) 859-5551

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W 8am-6pm, Th 8am-8pm,F 8am-5pm

S 8am - 5pm, Su 10am - 2pm

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

CERTIFICATIONS :

• Inhalation Sedation

#021838

Main Street Children's Dentistry

& Orthodontics Coral Spring

7663 W Sample Road

Coral Springs, FL 33065

(954) 906-9756

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN20024 Roberti, Sabrina

NPI: 1841632924 LIC: DN20024

CERTIFICATIONS :

#011303

Main Street Children's Dentistry

of Plantation

7115 W. Broward Blvd #155

Plantation, FL 33317

(954) 474-8849

Special Needs: Yes

Spanish

M-T 9am-5pm

Th-F 9am-5pm

# DN17117 Akerman, Carolina

NPI: 1205924560 LIC: DN17117

CERTIFICATIONS :

• Inhalation Sedation

# DN18168 Correa, Paola

NPI: 1497945083 LIC: DN18168

CERTIFICATIONS :

• Inhalation Sedation

# DN18553 Munoz, Zulima

NPI: 1063659811 LIC: DN18553

CERTIFICATIONS :

• Inhalation Sedation

#011306

Main Street Children's Dentistry

of South Broward

9900 Stirling Road, Ste 100

Cooper City, FL 33024

(954) 432-8707

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W 8am-4pm, Th 9am-5pm,F 8am-4pm

# DN18168 Correa, Paola*

NPI: 1497945083 LIC: DN18168

CERTIFICATIONS :

• Inhalation Sedation

# DN18718 Gallego, Ana Maria*

NPI: 1396034401 LIC: DN18718

CERTIFICATIONS :

• Inhalation Sedation

#016573

Mini Mouths Dentistry

700 N. Hiatus Rd Ste 101

Pembroke Pines, FL 33026

www.minimouths.com

(754) 217-4633

Special Needs: Yes

English, Spanish, Portuguese

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

M-T 8am-5pm

W-F 8am-5pm

# DN20130 Avman, Selin

NPI: 1750636049 LIC: DN20130

CERTIFICATIONS :

• Inhalation Sedation

# DN19597 Rosenfeld, Dalia

NPI: 1134496037 LIC: DN19597

CERTIFICATIONS :

• Inhalation Sedation

#016172

Mini Mouths Dentistry for

Children

5481 N. University Dr Ste 102

Coral Springs, FL 33067

(954) 575-5488

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-Th 8am-5pm

# DN20130 Avman, Selin

NPI: 1750636049 LIC: DN20130

CERTIFICATIONS :

• Inhalation Sedation

# DN19597 Rosenfeld, Dalia

NPI: 1134496037 LIC: DN19597

CERTIFICATIONS :

• Inhalation Sedation

#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

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

#020830

Patricia Gonzalez Templeton,

DDS, LLC

2249 N University Dr.

Pembroke Pnes, FL 33024

www.smileprotector.com

(954) 983-1680

Special Needs: Yes

English, Russian, French, Hebrew,

Spanish

T 8am - 3pm

W 8am-3pm,

# DN6139 Sherman, Richard

NPI: 1306904164 LIC: DN6139

CERTIFICATIONS :

# DN14445 Templeton, Patricia

NPI: 1881751956 LIC: DN14445

CERTIFICATIONS :

#007926

Pediatric Dental Centers of

Broward

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

8351 W. Atlantic Blvd

Coral Springs, FL 33071

(954) 341-0002

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 2pm

# DN17284 Acosta, Enrique

NPI: 1790708865 LIC: DN17284

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22070 Godoy, Daniella

NPI: 1740770213 LIC: DN22070

CERTIFICATIONS :

• Inhalation Sedation

# DN20908 Mutawalli, Khalid

NPI: 1750754818 LIC: DN20908

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19595 Trujillo, Maria

NPI: 1942598404 LIC: DN19595

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#011411

Pediatric Dental Land, Inc

8320 W. Sunrise Blvd, Ste #210

Plantation, FL 33322

www.pediatricdentalland.com

(954) 414-8018

Special Needs: Yes

Spanish

M 8am - 5pm, T 8am - 6pm

W-F 8am-5pm

# DN19059 D'Alessandria, Nestor

NPI: 1114239787 LIC: DN19059

CERTIFICATIONS :

• Inhalation Sedation

# DN22070 Godoy, Daniella

NPI: 1740770213 LIC: DN22070

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#020914

Smile Design Of Hallandale

Beach LLC

2100 E Hallandale Beach Blvd, Ste

305

Hallandale Beach, FL 33009

(954) 454-4949

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21814 Criscuolo, Stephen

NPI: 1053792168 LIC: DN21814

CERTIFICATIONS :

• Inhalation Sedation

#015848

Smile Everyday Plantation

7500 Nw 5Th Street, Ste 107

Plantation, FL 33317

(954) 682-8000

Special Needs: Yes

English, Spanish

M-T 9am-7pm

W-F 9am-7pm

S 9am - 3pm

# DN21814 Criscuolo, Stephen

NPI: 1053792168 LIC: DN21814

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#015846

Smile Everyday Tamarac

8311 N Pine Island Road

Tamarac, FL 33321

smileeverydaydentistry.com

(954) 682-8000

Special Needs: Yes

English, Arabic, Spanish

M-T 8am-7pm

W-F 8am-7pm

S 8am - 3pm

# DN21814 Criscuolo, Stephen

NPI: 1053792168 LIC: DN21814

CERTIFICATIONS :

• Inhalation Sedation

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#015576

Sunshine Pediatric Dentistry

5000 Hollywood Blvd, Ste 1

Hollywood, FL 33021

(954) 989-4400

Special Needs: Yes

English, Spanish

M 8am - 5pm, T 8am - 4pm

# DN18966 Rodriguez, Claudia

NPI: 1700103686 LIC: DN18966

CERTIFICATIONS :

• Inhalation Sedation

#007870

Super Smiles Pediatric Dentistry

& Orthodontics

815 S. University Dr. Ste #100

Plantation, FL 33324

(954) 473-6900

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other), Portuguese

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

CERTIFICATIONS :

• Inhalation Sedation

# DN20401 Buscemi, Amanda

NPI: 1669808572 LIC: DN20401

CERTIFICATIONS :

• Inhalation Sedation

# DN21064 Storch, Dana

NPI: 1801219563 LIC: DN21064

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 26 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#017011

Super Smiles Pediatric Dentistry

& Orthodontics

1670 N. University Dr Ste B

Coral Springs, FL 33071

(954) 346-8108

Special Needs: Yes

English, Spanish, French

M-T 8am-5pm

W-F 8am-5pm

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

CERTIFICATIONS :

• Inhalation Sedation

# DN20401 Buscemi, Amanda

NPI: 1669808572 LIC: DN20401

CERTIFICATIONS :

• Inhalation Sedation

# DN21064 Storch, Dana

NPI: 1801219563 LIC: DN21064

CERTIFICATIONS :

• Inhalation Sedation

#007556

Tiki Dental

501 Golden Isles Dr., Ste 202

Hallandale, FL 33009

www.tikidental.com

(954) 889-8889

Special Needs: Yes

Spanish, English

M 9am - 5pm,

W-Th 9am-5pm

# DN15540 Adelson, Jennifer

NPI: 1588868962 LIC: DN15540

CERTIFICATIONS :

• Inhalation Sedation

#019690

TLC Dental 4 Kids, LLC

3001 E. Commercial Blvd

Fort Lauderdale, FL 33308

(954) 414-4633

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), French,

Portuguese

T 9am - 5pm

W 12pm-7pm,

# DN13411 Thomas, Christian

NPI: 1689862674 LIC: DN13411

CERTIFICATIONS :

#021133

Urrea-Feldsberg DDS, PA

12301 Taft St. Ste 300

Pembroke Pines, FL 33026

www.browardpediatricdentists.com

(954) 435-5900

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17836 Smith, Christina

NPI: 1104963149 LIC: DN17836

CERTIFICATIONS :

• Inhalation Sedation

# DN16226 Urrea-Feldsberg, Helena

NPI: 1982772877 LIC: DN16226

CERTIFICATIONS :

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 :

#010649

Plantation Dental Services, P.A.

314 S. University Drive

Plantation, FL 33324

(954) 474-8475

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17440 Oliver, Francisco

NPI: 1437316510 LIC: DN17440

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

#CHC10235

DOH - Calhoun County Health

Department (School Based)

19611 State Road 20 West

Blountstown, FL 32424

(850) 643-2415

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19827 Barth, Nicholas*

NPI: 1396090320 LIC: DN19827

CERTIFICATIONS :

• Inhalation Sedation

# DN18661 Whitford, Drew*

NPI: 1851527303 LIC: DN18661

CERTIFICATIONS :

• Inhalation Sedation

#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

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1578685491 LIC: HAD79

CERTIFICATIONS :

# HAD100 Miles, Kenneth

NPI: 1063563724 LIC: HAD100

CERTIFICATIONS :

#FQHC010645

Family Health Centers of

Southwest Florida, Inc.

4300 Kings Hwy, Ste #500

Port Charlotte, FL 33980

(239) 344-2337

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#021672

Pediatric Dentistry of Port

Charlotte

3872 Tamiami Trail, Unit D & E

Port Charlotte, FL 33952

(941) 391-8090

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN15921 Argumosa, Miguel*

NPI: 1184653347 LIC: DN15921

CERTIFICATIONS :

• Board Certification

# DN18365 Ascunce, Leanet*

NPI: 1710130661 LIC: DN18365

CERTIFICATIONS :

• Inhalation Sedation

# DN20011 Eastham, Nicole*

NPI: 1699039867 LIC: DN20011

CERTIFICATIONS :

# DN17031 Taylor, Erin*

NPI: 1417018953 LIC: DN17031

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

CITRUS COUNTY

DENTIST

#022662

Citrus Springs Dental Care PLLC

9535 N Citrus Springs Blvd

Citrus Springs, FL 34434

(352) 465-3008

Special Needs: Yes

English

M-T 8am-4pm

W 8am-4pm,

# DN19041 Chapagain, Shweta

NPI: 1346561396 LIC: DN19041

CERTIFICATIONS :

• Inhalation Sedation

#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 :

#010854

Great Expressions Dental Centers

1605-110 County Road 220

Fleming Island, FL 32003

(904) 215-3533

Special Needs: Yes

English, Russian, Sign Languages,

Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

CERTIFICATIONS :

• Inhalation Sedation

# DN23229 Ovsiy, Olexandra

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1528595907 LIC: DN23229

CERTIFICATIONS :

# DN9719 Santos, Remedios

NPI: 1821144213 LIC: DN9719

CERTIFICATIONS :

• Inhalation Sedation

# DN19713 Wright, Miranda

NPI: 1083977938 LIC: DN19713

CERTIFICATIONS :

#015110

Greenberg Dental - Orange Park

1562 Wells Rd, Ste 16

Orange Park, FL 32073

(904) 644-0140

Special Needs: Yes

English, Spanish, Tagalog

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

S 8am - 1pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#010393

Greenberg Dental & Orthodontics

1340 Blanding Blvd, Ste 108

Orange Park, FL 32065

(904) 639-6924

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#020600

Greenberg Dental & Orthodontics

2710 Blanding Blvd Ste 3

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Middleburg, FL 32068

(904) 637-1148

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 10am - 6pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

#014119

Greenberg Dental & Orthodontics

1985 Eastwest Pkwy

Fleming Island, FL 32003

(904) 639-6091

Special Needs: Yes

English, Spanish

M-T 7am-3pm

Th-F 7am-3pm

S 8am - 3pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#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 :

ENDODONTICS

#019277

Dr. Michael R. Smith D.M.D. PA

1520 Business Center Dr. #2

Orange Park, FL 32003

(904) 637-0028

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 30 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Spanish

M-T 7am-4pm

W-Th 7am-4pm

# DN13788 Smith, Michael

NPI: 1285764860 LIC: DN13788

CERTIFICATIONS :

• Inhalation Sedation

#015110

Greenberg Dental - Orange Park

1562 Wells Rd, Ste 16

Orange Park, FL 32073

(904) 644-0140

Special Needs: Yes

English, Spanish, Tagalog

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

S 8am - 1pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#010393

Greenberg Dental & Orthodontics

1340 Blanding Blvd, Ste 108

Orange Park, FL 32065

(904) 639-6924

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#020600

Greenberg Dental & Orthodontics

2710 Blanding Blvd Ste 3

Middleburg, FL 32068

(904) 637-1148

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 10am - 6pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#014119

Greenberg Dental & Orthodontics

1985 Eastwest Pkwy

Fleming Island, FL 32003

(904) 639-6091

Special Needs: Yes

English, Spanish

M-T 7am-3pm

Th-F 7am-3pm

S 8am - 3pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

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 31 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

ORAL SURGEON

#015110

Greenberg Dental - Orange Park

1562 Wells Rd, Ste 16

Orange Park, FL 32073

(904) 644-0140

Special Needs: Yes

English, Spanish, Tagalog

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

S 8am - 1pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#010393

Greenberg Dental & Orthodontics

1340 Blanding Blvd, Ste 108

Orange Park, FL 32065

(904) 639-6924

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#020600

Greenberg Dental & Orthodontics

2710 Blanding Blvd Ste 3

Middleburg, FL 32068

(904) 637-1148

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 10am - 6pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#014119

Greenberg Dental & Orthodontics

1985 Eastwest Pkwy

Fleming Island, FL 32003

(904) 639-6091

Special Needs: Yes

English, Spanish

M-T 7am-3pm

Th-F 7am-3pm

S 8am - 3pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#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

ORTHODONTIST

#015110

Greenberg Dental - Orange Park

1562 Wells Rd, Ste 16

Orange Park, FL 32073

(904) 644-0140

Special Needs: Yes

English, Spanish, Tagalog

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

S 8am - 1pm

# DN18750 Bouvier, Amy

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#010393

Greenberg Dental & Orthodontics

1340 Blanding Blvd, Ste 108

Orange Park, FL 32065

(904) 639-6924

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#020600

Greenberg Dental & Orthodontics

2710 Blanding Blvd Ste 3

Middleburg, FL 32068

(904) 637-1148

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 10am - 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 32 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN18750 Bouvier, Amy

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN17052 Long, Ryan

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#010854

Great Expressions Dental Centers

1605-110 County Road 220

Fleming Island, FL 32003

(904) 215-3533

Special Needs: Yes

English, Russian, Sign Languages,

Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18619 Kuhl, Philip

NPI: 1265668586 LIC: DN18619

CERTIFICATIONS :

• Inhalation Sedation

#015110

Greenberg Dental - Orange Park

1562 Wells Rd, Ste 16

Orange Park, FL 32073

(904) 644-0140

Special Needs: Yes

English, Spanish, Tagalog

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

S 8am - 1pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#010393

Greenberg Dental & Orthodontics

1340 Blanding Blvd, Ste 108

Orange Park, FL 32065

(904) 639-6924

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#020600

Greenberg Dental & Orthodontics

2710 Blanding Blvd Ste 3

Middleburg, FL 32068

(904) 637-1148

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 10am - 6pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#014119

Greenberg Dental & Orthodontics

1985 Eastwest Pkwy

Fleming Island, FL 32003

(904) 639-6091

Special Needs: Yes

English, Spanish

M-T 7am-3pm

Th-F 7am-3pm

S 8am - 3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

#015110

Greenberg Dental - Orange Park

1562 Wells Rd, Ste 16

Orange Park, FL 32073

(904) 644-0140

Special Needs: Yes

English, Spanish, Tagalog

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

S 8am - 1pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#010393

Greenberg Dental & Orthodontics

1340 Blanding Blvd, Ste 108

Orange Park, FL 32065

(904) 639-6924

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#020600

Greenberg Dental & Orthodontics

2710 Blanding Blvd Ste 3

Middleburg, FL 32068

(904) 637-1148

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 10am - 6pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#014119

Greenberg Dental & Orthodontics

1985 Eastwest Pkwy

Fleming Island, FL 32003

(904) 639-6091

Special Needs: Yes

English, Spanish

M-T 7am-3pm

Th-F 7am-3pm

S 8am - 3pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

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 33 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious 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 :

#011001

Great Expressions Dental Centers

5022 Airport Pulling Road North,

Unit 22

Naples, FL 34105

(239) 649-0598

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN10744 Fidler, Russell

NPI: 1801973466 LIC: DN10744

CERTIFICATIONS :

# DN19883 Mier Parsons, Andrea

NPI: 1306104351 LIC: DN19883

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*

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# 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

#011304

Dental Specialty Center of Naples

4955 Castello Drive

Naples, FL 34103

www.dentalspecialtyflorida.com

(239) 213-1733

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M 8am - 5pm, T 8am - 6pm

W-F 8am-5pm

# DN17756 Galsterer, Mark

NPI: 1780733469 LIC: DN17756

CERTIFICATIONS :

• Inhalation Sedation

#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 :

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

ORAL SURGEON

#011304

Dental Specialty Center of Naples

4955 Castello Drive

Naples, FL 34103

www.dentalspecialtyflorida.com

(239) 213-1733

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M 8am - 5pm, T 8am - 6pm

W-F 8am-5pm

# DN21883 Hall, Kevin

NPI: 1447512421 LIC: DN21883

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN19286 Rand, Matthew

NPI: 1740407030 LIC: DN19286

CERTIFICATIONS :

• General Anesthesia

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

# HAD98 Keck, Douglas*

NPI: 1710988704 LIC: HAD98

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

# DN17804 Gedeon, Rose

NPI: 1063547545 LIC: DN17804

CERTIFICATIONS :

• Inhalation Sedation

# HAD98 Keck, Douglas

NPI: 1710988704 LIC: HAD98

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

# DN17804 Gedeon, Rose

NPI: 1063547545 LIC: DN17804

CERTIFICATIONS :

• Inhalation Sedation

# HAD98 Keck, Douglas

NPI: 1710988704 LIC: HAD98

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

# DN17804 Gedeon, Rose

NPI: 1063547545 LIC: DN17804

CERTIFICATIONS :

• Inhalation Sedation

#012326

Main Street Children's Dentistry

and Orthodontics of Naples

6726 Lone Oak Blvd

Naples, FL 34109

(239) 254-0085

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN18365 Ascunce, Leanet

NPI: 1710130661 LIC: DN18365

CERTIFICATIONS :

• Inhalation Sedation

# DN18553 Munoz, Zulima

NPI: 1063659811 LIC: DN18553

CERTIFICATIONS :

• Inhalation Sedation

#021398

NCEF Pediatric Dental Center

7505 Grand Lely Drive

Naples, FL 34113

www.ufl.edu

(239) 920-4523

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN10507 Governale, Lauren

NPI: 1174614465 LIC: DN10507

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19083 Hester, Jordan

NPI: 1972814820 LIC: DN19083

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21762 Lastres, Joana

NPI: 1538577549 LIC: DN21762

CERTIFICATIONS :

• Inhalation Sedation

# DN16020 Magher, Kelly

NPI: 1063527828 LIC: DN16020

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19444 Morin, Aline

NPI: 1932487725 LIC: DN19444

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#021925

Tim M. Verwest DMD, Pediatric

Dentistry of FL

1035 Piper Blvd. Ste 103

Naples, FL 34110

(239) 482-2722

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-5pm,

# DN23996 Liu, Tong

NPI: 1043665227 LIC: DN23996

CERTIFICATIONS :

# DN12089 Verwest, Tim

NPI: 1013981620 LIC: DN12089

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#021581

Young & Royal, LLC

12975 Collier Blvd, Ste 302

Naples, FL 34116

www.youngnroyal.com

(239) 331-2184

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 36 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Farsi, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 2pm

# DN20379 Josephs, Elias

NPI: 1942511803 LIC: DN20379

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

#011304

Dental Specialty Center of Naples

4955 Castello Drive

Naples, FL 34103

www.dentalspecialtyflorida.com

(239) 213-1733

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M 8am - 5pm, T 8am - 6pm

W-F 8am-5pm

# DN19411 Broderick, Anne

NPI: 1831419456 LIC: DN19411

CERTIFICATIONS :

• Inhalation Sedation

#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

#CHC010298

DOH - Columbia County Health

Dept -SCHOOL BASED

LOCATION

217 Ne Franklin St

Lake City, FL 32055

(386) 752-9914

Special Needs: Yes

English

M-T 7am-4pm

W-F 7am-4pm

# DN23407 Allin, Naveen

NPI: 1316439193 LIC: DN23407

CERTIFICATIONS :

# DN15416 Elam, Christine

NPI: 1922136092 LIC: DN15416

CERTIFICATIONS :

# DN16796 Nguyen, Phuc-Hau

NPI: 1831303759 LIC: DN16796

CERTIFICATIONS :

# DN11385 Traul Jr., Robert

NPI: 1982734257 LIC: DN11385

CERTIFICATIONS :

#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

NPI: 1295996767 LIC: DN18285

CERTIFICATIONS :

DIXIE COUNTY

DENTIST

#CHC015360

DOH - Dixie County Health

Department

149 Ne 241St St

Cross City, FL 32628

(352) 498-1360

Special Needs: Yes

English

# DN15416 Elam, Christine

NPI: 1922136092 LIC: DN15416

CERTIFICATIONS :

# DN14796 Turner, David

NPI: 1679894257 LIC: DN14796

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN20613 Martin, Shakela

NPI: 1639582943 LIC: DN20613

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 :

#CHC7382

DOH - Duval County Health

Department

3225 University Blvd South Ste 200

Jacksonville, FL 32216

(904) 253-2017

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN5728 Grim, John

NPI: 1457399214 LIC: DN5728

CERTIFICATIONS :

# DN9281 McCravy, Laurier

NPI: 1821078718 LIC: DN9281

CERTIFICATIONS :

# DN15901 Mertz Jr., Kenneth

NPI: 1003882184 LIC: DN15901

CERTIFICATIONS :

# DN10583 Morrell-Wallace, Cynthia

NPI: 1932367414 LIC: DN10583

CERTIFICATIONS :

# DN17228 Nahar, Anita

NPI: 1073568820 LIC: DN17228

CERTIFICATIONS :

# DN10404 Varnado, Phillis

NPI: 1265486260 LIC: DN10404

CERTIFICATIONS :

# DN12981 Walo, Rosalie

NPI: 1164476172 LIC: DN12981

CERTIFICATIONS :

#CHC7385

DOH - Duval County Health

Department- Mobile Dental Unit

515 W. 6Th St

Jacksonville, FL 32206

(904) 253-1230

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN5728 Grim, John

NPI: 1457399214 LIC: DN5728

CERTIFICATIONS :

# DN9281 McCravy, Laurier

NPI: 1821078718 LIC: DN9281

CERTIFICATIONS :

# DN15901 Mertz Jr., Kenneth

NPI: 1003882184 LIC: DN15901

CERTIFICATIONS :

# DN10583 Morrell-Wallace, Cynthia

NPI: 1932367414 LIC: DN10583

CERTIFICATIONS :

# DN17228 Nahar, Anita

NPI: 1073568820 LIC: DN17228

CERTIFICATIONS :

# DN10404 Varnado, Phillis

NPI: 1265486260 LIC: DN10404

CERTIFICATIONS :

# DN12981 Walo, Rosalie

NPI: 1164476172 LIC: DN12981

CERTIFICATIONS :

#CHC7386

DOH - Duval County North Point

Dental

3416 Moncrief Rd

Jacksonville, FL 32209

(904) 253-1783

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN5728 Grim, John

NPI: 1457399214 LIC: DN5728

CERTIFICATIONS :

# DN9281 McCravy, Laurier

NPI: 1821078718 LIC: DN9281

CERTIFICATIONS :

# DN15901 Mertz Jr., Kenneth

NPI: 1003882184 LIC: DN15901

CERTIFICATIONS :

# DN10583 Morrell-Wallace, Cynthia

NPI: 1932367414 LIC: DN10583

CERTIFICATIONS :

# DN17228 Nahar, Anita

NPI: 1073568820 LIC: DN17228

CERTIFICATIONS :

# DN10404 Varnado, Phillis

NPI: 1265486260 LIC: DN10404

CERTIFICATIONS :

# DN12981 Walo, Rosalie

NPI: 1164476172 LIC: DN12981

CERTIFICATIONS :

#021393

Duval Dental

376 New Berlin Rd Ste #1

Jacksonville, FL 32218

(904) 696-3336

Special Needs: No

English

M 9am - 5pm, T 8am - 5pm

W 9am-2pm, Th 8am-5pm

# DN13001 Smith, Daryl

NPI: 1881704559 LIC: DN13001

CERTIFICATIONS :

• Inhalation Sedation

#015256

Economy Dentistry

3615 Dupont Ave, Ste 200-400

Jacksonville, FL 32217

(904) 683-1769

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 5pm

# DN16236 Calcagno, Manuel

NPI: 1194866616 LIC: DN16236

CERTIFICATIONS :

# DN22166 De Jesus, Joseph

NPI: 1376996652 LIC: DN22166

CERTIFICATIONS :

• Inhalation Sedation

# DN12624 Di Re, Anthony

NPI: 1487764528 LIC: DN12624

CERTIFICATIONS :

# DN20867 Diaz Suarez, Natalia

NPI: 1437574761 LIC: DN20867

CERTIFICATIONS :

# DN21367 Farrell, Thomas

NPI: 1417368911 LIC: DN21367

CERTIFICATIONS :

# DN12237 Figaro, Mark

NPI: 1952516965 LIC: DN12237

CERTIFICATIONS :

# DN13453 Giradeau, Otis

NPI: 1710023551 LIC: DN13453

CERTIFICATIONS :

• Inhalation Sedation

# DN20374 Gottipati, Padmalatha

NPI: 1013340405 LIC: DN20374

CERTIFICATIONS :

• Inhalation Sedation

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN8532 Grier, Carrol

NPI: 1750335857 LIC: DN8532

CERTIFICATIONS :

• Inhalation Sedation

# DN8243 Polite, Leroy

NPI: 1740383017 LIC: DN8243

CERTIFICATIONS :

# DN8598 Pratt, Frederick

NPI: 1316141591 LIC: DN8598

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN13001 Smith, Daryl

NPI: 1881704559 LIC: DN13001

CERTIFICATIONS :

• Inhalation Sedation

# DN16874 Vo, Jossette

NPI: 1699821074 LIC: DN16874

CERTIFICATIONS :

• Inhalation Sedation

# DN15082 Wright, Carl

NPI: 1114943834 LIC: DN15082

CERTIFICATIONS :

• Inhalation Sedation

#013107

Economy Dentistry for Children

General Dentistry

1680 Dunn Ave Ste 31

Jacksonville, FL 32218

(904) 751-1275

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 2pm

# DN22166 De Jesus, Joseph*

NPI: 1376996652 LIC: DN22166

CERTIFICATIONS :

• Inhalation Sedation

# DN12237 Figaro, Mark

NPI: 1952516965 LIC: DN12237

CERTIFICATIONS :

# DN13453 Giradeau, Otis

NPI: 1710023551 LIC: DN13453

CERTIFICATIONS :

• Inhalation Sedation

# DN20374 Gottipati, Padmalatha

NPI: 1013340405 LIC: DN20374

CERTIFICATIONS :

• Inhalation Sedation

# DN8532 Grier, Carrol

NPI: 1750335857 LIC: DN8532

CERTIFICATIONS :

• Inhalation Sedation

# DN8243 Polite, Leroy

NPI: 1740383017 LIC: DN8243

CERTIFICATIONS :

# DN13001 Smith, Daryl

NPI: 1881704559 LIC: DN13001

CERTIFICATIONS :

• Inhalation Sedation

# DN16874 Vo, Jossette

NPI: 1699821074 LIC: DN16874

CERTIFICATIONS :

• Inhalation Sedation

# DN15082 Wright, Carl

NPI: 1114943834 LIC: DN15082

CERTIFICATIONS :

• Inhalation Sedation

#009179

Family Dentistry

1440-1 Dunn Ave

Jacksonville, FL 32218

(904) 757-2500

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN11247 Desai, Bharatkumar

NPI: 1205125424 LIC: DN11247

CERTIFICATIONS :

#010846

Great Expressions Dental Centers

3706 Blanding Blvd

Jacksonville, FL 32210

(904) 777-1477

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN24310 Draper, John

NPI: 1457912263 LIC: DN24310

CERTIFICATIONS :

# DN9719 Santos, Remedios

NPI: 1821144213 LIC: DN9719

CERTIFICATIONS :

• Inhalation Sedation

# DN21403 Truong, Vy

NPI: 1972986479 LIC: DN21403

CERTIFICATIONS :

#010856

Great Expressions Dental Centers

3714 Heath Road

Jacksonville, FL 32277

(904) 302-7552

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

CERTIFICATIONS :

• Inhalation Sedation

# DN20120 Nofallah, Sara

NPI: 1457799579 LIC: DN20120

CERTIFICATIONS :

• Inhalation Sedation

# DN9719 Santos, Remedios

NPI: 1821144213 LIC: DN9719

CERTIFICATIONS :

• Inhalation Sedation

#010981

Great Expressions Dental Centers

9109 Baymeadows Road, Ste #1

Jacksonville, FL 32256

(904) 731-4343

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19529 Davis, Anthony

NPI: 1184766545 LIC: DN19529

CERTIFICATIONS :

• Inhalation Sedation

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

CERTIFICATIONS :

• Inhalation Sedation

# DN23229 Ovsiy, Olexandra

NPI: 1528595907 LIC: DN23229

CERTIFICATIONS :

# DN22782 Patel, Tanvi

NPI: 1437679966 LIC: DN22782

CERTIFICATIONS :

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#010992

Great Expressions Dental Centers

3704 Heath Road

Jacksonville, FL 32277

(904) 743-6380

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN20120 Nofallah, Sara

NPI: 1457799579 LIC: DN20120

CERTIFICATIONS :

• Inhalation Sedation

# DN9719 Santos, Remedios

NPI: 1821144213 LIC: DN9719

CERTIFICATIONS :

• Inhalation Sedation

# DN9001 Tannen, Mildred

NPI: 1285858415 LIC: DN9001

CERTIFICATIONS :

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#010993

Great Expressions Dental Centers

1519 3Rd Street N

Jacksonville, FL 32250

(904) 241-0880

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19493 De Loach, Melanie

NPI: 1053690222 LIC: DN19493

CERTIFICATIONS :

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

CERTIFICATIONS :

• Inhalation Sedation

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#010995

Great Expressions Dental Centers

1403-10 Dunn Ave

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Jacksonville, FL 32218

(904) 751-3444

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN22113 Davis, Dillon

NPI: 1891147914 LIC: DN22113

CERTIFICATIONS :

# DN19493 De Loach, Melanie

NPI: 1053690222 LIC: DN19493

CERTIFICATIONS :

# DN23917 McKinney, Sharod

NPI: 1235689720 LIC: DN23917

CERTIFICATIONS :

# DN9001 Tannen, Mildred

NPI: 1285858415 LIC: DN9001

CERTIFICATIONS :

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#010996

Great Expressions Dental Centers

5218 James Road, Ste D

Jacksonville, FL 32210

(904) 778-0990

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN24310 Draper, John

NPI: 1457912263 LIC: DN24310

CERTIFICATIONS :

# DN22938 Sanchez, Diego

NPI: 1902329816 LIC: DN22938

CERTIFICATIONS :

#011000

Great Expressions Dental Centers

9119 Merrill Road, Ste # 29 & 30

Jacksonville, FL 32225

(904) 744-7202

Special Needs: Yes

English

M 8am - 5pm,

W-Th 8am-5pm

# DN11948 Clark, Patricia

NPI: 1871677476 LIC: DN11948

CERTIFICATIONS :

# DN19529 Davis, Anthony

NPI: 1184766545 LIC: DN19529

CERTIFICATIONS :

• Inhalation Sedation

# DN19493 De Loach, Melanie

NPI: 1053690222 LIC: DN19493

CERTIFICATIONS :

# DN18407 Margulis, Jeffrey

NPI: 1720493612 LIC: DN18407

CERTIFICATIONS :

# DN24094 Marquez, Stephanie

NPI: 1437706462 LIC: DN24094

CERTIFICATIONS :

# DN9001 Tannen, Mildred

NPI: 1285858415 LIC: DN9001

CERTIFICATIONS :

# DN22634 Weaver, Damone

NPI: 1134658818 LIC: DN22634

CERTIFICATIONS :

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#011002

Great Expressions Dental Centers

7909 Normandy Blvd

Jacksonville, FL 32221

(904) 786-1309

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN20821 Boykin, DeShaydia

NPI: 1720496144 LIC: DN20821

CERTIFICATIONS :

# DN19493 De Loach, Melanie

NPI: 1053690222 LIC: DN19493

CERTIFICATIONS :

#011008

Great Expressions Dental Centers

751 Oak Street, Ste 601

Jacksonville, FL 32204

(904) 354-4031

Special Needs: Yes

English

M-T 7am-3pm

W-F 7am-3pm

# DN10882 Boldt, Paul

NPI: 1992992028 LIC: DN10882

CERTIFICATIONS :

# DN11948 Clark, Patricia

NPI: 1871677476 LIC: DN11948

CERTIFICATIONS :

# DN24094 Marquez, Stephanie

NPI: 1437706462 LIC: DN24094

CERTIFICATIONS :

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

CERTIFICATIONS :

• Inhalation Sedation

# DN9001 Tannen, Mildred

NPI: 1285858415 LIC: DN9001

CERTIFICATIONS :

#011009

Great Expressions Dental Centers

14286-23 Beach Blvd

Jacksonville, FL 32250

(904) 821-9555

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN17174 Hicks, Katherine

NPI: 1407902893 LIC: DN17174

CERTIFICATIONS :

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

CERTIFICATIONS :

• Inhalation Sedation

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#011010

Great Expressions Dental Centers

3733 Southside Blvd, Ste # 5 & 6

Jacksonville, FL 32216

(904) 996-0111

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN22113 Davis, Dillon

NPI: 1891147914 LIC: DN22113

CERTIFICATIONS :

# DN19493 De Loach, Melanie

NPI: 1053690222 LIC: DN19493

CERTIFICATIONS :

# DN9719 Santos, Remedios

NPI: 1821144213 LIC: DN9719

CERTIFICATIONS :

• Inhalation Sedation

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#014135

Great Expressions Dental Centers

9000 Golfside Dr Ste A

Jacksonville, FL 32256

(904) 737-8410

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN18407 Margulis, Jeffrey

NPI: 1720493612 LIC: DN18407

CERTIFICATIONS :

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

CERTIFICATIONS :

• Inhalation Sedation

#016229

Great Expressions Dental Centers

12420 San Jose Blvd

Jacksonville, FL 32223

(904) 268-3002

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21266 Moore, Kristen

NPI: 1376926154 LIC: DN21266

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 40 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#015100

Greenberg Dental - Atlantic Beach

1023 Atlantic Blvd

Atlantic Beach, FL 32233

(904) 249-3104

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-F 7am-3pm

S 8am - 4pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015106

Greenberg Dental - Bartram Park

13820 Old St. Augustine Rd, Ste 105

Jacksonville, FL 32258

(904) 260-7700

Special Needs: Yes

English, Russian, Spanish

M-T 7am-6pm

W 7am-7pm, Th 7am-4pm,F 7am-3pm

S 8am - 1pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015136

Greenberg Dental - Baymeadows

9978 Old Baymeadows Rd, Ste 1

Jacksonville, FL 32256

(904) 645-5015

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-Th 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 41 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

S 8am - 2pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015122

Greenberg Dental - Blanding

5116 Blanding Blvd

Jacksonville, FL 32210

(904) 573-7900

Special Needs: Yes

Spanish

M 9am - 5pm, T 7am - 3pm

W 7am-3pm, Th 3pm-7pm,F

7am-3pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015102

Greenberg Dental - Mandarin

10601 San Jose Blvd, Ste 117

Jacksonville, FL 32257

(904) 483-3027

Special Needs: Yes

M 7am - 3pm, T 10am - 6pm

W-F 7am-3pm

S 8am - 2pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015123

Greenberg Dental - Normandy

5149 Normandy Blvd, Unit 4

Jacksonville, FL 32205

(904) 781-1201

Special Needs: Yes

English

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015101

Greenberg Dental - Northside

1036 Dunn Ave Ste 42

Jacksonville, FL 32218

(904) 714-9909

Special Needs: Yes

English, Spanish

M 7am - 6pm, T 7am - 5pm

W-Th 7am-6pm

S 8am - 3pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

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 43 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015127

Greenberg Dental - Regency

620 Commerce Center Dr Unit 155

Jacksonville, FL 32225

(904) 483-3022

Special Needs: Yes

Spanish

M 10am - 6pm, T 7am - 3pm

W-F 7am-3pm

S 8am - 3pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015107

Greenberg Dental - San Pablo

14444 Beach Blvd, Ste 2

Jacksonville, FL 32250

(904) 223-4939

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-Th 8am-4pm

S 8am - 2pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

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 44 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#015126

Greenberg Dental -

University-Jacksonville

5937 University Blvd W.

Jacksonville, FL 32216

(904) 730-4150

Special Needs: Yes

Spanish, French

M 9am - 5pm, T 7am - 3pm

W-F 7am-3pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#010603

Greenberg Dental & Orthodontics

10095 Beach Blvd, Ste 150

Jacksonville, FL 32246

(904) 647-2050

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 10am - 6pm

Th-F 7am-3pm

S 8am - 2pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#018489

Greenberg Dental & Orthodontics

11043 Crystal Springs Rd Ste 20

Jacksonville, FL 32221

(904) 236-6250

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

Th-F 8am-4pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

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

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 :

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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

#008949

Soutel Dental Center

5475 Soutel Drive

Jacksonville, FL 32219

(904) 764-4576

Special Needs:

English

M-T 8am-5pm

W 7am-2pm, Th 8am-5pm

# DN14137 Clark Jr, Bennie

NPI: 1437173697 LIC: DN14137

CERTIFICATIONS :

• Inhalation Sedation

#CHC7384

Westside Dental Center

120 King Street

Jacksonville, FL 32204

(904) 253-1680

Special Needs: Yes

M-T 8am-5pm

W-F 8am-5pm

# DN5728 Grim, John

NPI: 1457399214 LIC: DN5728

CERTIFICATIONS :

# DN9281 McCravy, Laurier

NPI: 1821078718 LIC: DN9281

CERTIFICATIONS :

# DN15901 Mertz Jr., Kenneth

NPI: 1003882184 LIC: DN15901

CERTIFICATIONS :

# DN10583 Morrell-Wallace, Cynthia

NPI: 1932367414 LIC: DN10583

CERTIFICATIONS :

# DN17228 Nahar, Anita

NPI: 1073568820 LIC: DN17228

CERTIFICATIONS :

# DN10404 Varnado, Phillis

NPI: 1265486260 LIC: DN10404

CERTIFICATIONS :

# DN12981 Walo, Rosalie

NPI: 1164476172 LIC: DN12981

CERTIFICATIONS :

#015242

Zenovia Fulton, DMD

6476 Fort Caroline Road

Jacksonville, FL 32277

(904) 743-0900

Special Needs: No

T 8am - 5pm

W-Th 8am-5pm

# DN13608 Fulton, Zenovia

NPI: 1518291822 LIC: DN13608

CERTIFICATIONS :

ENDODONTICS

#010846

Great Expressions Dental Centers

3706 Blanding Blvd

Jacksonville, FL 32210

(904) 777-1477

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19093 Douglas, Bethany

NPI: 1437484128 LIC: DN19093

CERTIFICATIONS :

# DN19363 Serrano, Eric

NPI: 1184919334 LIC: DN19363

CERTIFICATIONS :

#011008

Great Expressions Dental Centers

751 Oak Street, Ste 601

Jacksonville, FL 32204

(904) 354-4031

Special Needs: Yes

English

M-T 7am-3pm

W-F 7am-3pm

# DN19093 Douglas, Bethany

NPI: 1437484128 LIC: DN19093

CERTIFICATIONS :

#011009

Great Expressions Dental Centers

14286-23 Beach Blvd

Jacksonville, FL 32250

(904) 821-9555

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN19363 Serrano, Eric

NPI: 1184919334 LIC: DN19363

CERTIFICATIONS :

#015100

Greenberg Dental - Atlantic Beach

1023 Atlantic Blvd

Atlantic Beach, FL 32233

(904) 249-3104

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-F 7am-3pm

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

S 8am - 4pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015106

Greenberg Dental - Bartram Park

13820 Old St. Augustine Rd, Ste 105

Jacksonville, FL 32258

(904) 260-7700

Special Needs: Yes

English, Russian, Spanish

M-T 7am-6pm

W 7am-7pm, Th 7am-4pm,F 7am-3pm

S 8am - 1pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015136

Greenberg Dental - Baymeadows

9978 Old Baymeadows Rd, Ste 1

Jacksonville, FL 32256

(904) 645-5015

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

S 8am - 2pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015122

Greenberg Dental - Blanding

5116 Blanding Blvd

Jacksonville, FL 32210

(904) 573-7900

Special Needs: Yes

Spanish

M 9am - 5pm, T 7am - 3pm

W 7am-3pm, Th 3pm-7pm,F

7am-3pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015102

Greenberg Dental - Mandarin

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

10601 San Jose Blvd, Ste 117

Jacksonville, FL 32257

(904) 483-3027

Special Needs: Yes

M 7am - 3pm, T 10am - 6pm

W-F 7am-3pm

S 8am - 2pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015123

Greenberg Dental - Normandy

5149 Normandy Blvd, Unit 4

Jacksonville, FL 32205

(904) 781-1201

Special Needs: Yes

English

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015101

Greenberg Dental - Northside

1036 Dunn Ave Ste 42

Jacksonville, FL 32218

(904) 714-9909

Special Needs: Yes

English, Spanish

M 7am - 6pm, T 7am - 5pm

W-Th 7am-6pm

S 8am - 3pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015127

Greenberg Dental - Regency

620 Commerce Center Dr Unit 155

Jacksonville, FL 32225

(904) 483-3022

Special Needs: Yes

Spanish

M 10am - 6pm, T 7am - 3pm

W-F 7am-3pm

S 8am - 3pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

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 49 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015107

Greenberg Dental - San Pablo

14444 Beach Blvd, Ste 2

Jacksonville, FL 32250

(904) 223-4939

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-Th 8am-4pm

S 8am - 2pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#015126

Greenberg Dental -

University-Jacksonville

5937 University Blvd W.

Jacksonville, FL 32216

(904) 730-4150

Special Needs: Yes

Spanish, French

M 9am - 5pm, T 7am - 3pm

W-F 7am-3pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#010603

Greenberg Dental & Orthodontics

10095 Beach Blvd, Ste 150

Jacksonville, FL 32246

(904) 647-2050

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 10am - 6pm

Th-F 7am-3pm

S 8am - 2pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#018489

Greenberg Dental & Orthodontics

11043 Crystal Springs Rd Ste 20

Jacksonville, FL 32221

(904) 236-6250

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

Th-F 8am-4pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• 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

# DN13421 Gittess, Robert

NPI: 1922137058 LIC: DN13421

CERTIFICATIONS :

ORAL SURGEON

#015100

Greenberg Dental - Atlantic Beach

1023 Atlantic Blvd

Atlantic Beach, FL 32233

(904) 249-3104

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-F 7am-3pm

S 8am - 4pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015106

Greenberg Dental - Bartram Park

13820 Old St. Augustine Rd, Ste 105

Jacksonville, FL 32258

(904) 260-7700

Special Needs: Yes

English, Russian, Spanish

M-T 7am-6pm

W 7am-7pm, Th 7am-4pm,F 7am-3pm

S 8am - 1pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015136

Greenberg Dental - Baymeadows

9978 Old Baymeadows Rd, Ste 1

Jacksonville, FL 32256

(904) 645-5015

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

S 8am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015122

Greenberg Dental - Blanding

5116 Blanding Blvd

Jacksonville, FL 32210

(904) 573-7900

Special Needs: Yes

Spanish

M 9am - 5pm, T 7am - 3pm

W 7am-3pm, Th 3pm-7pm,F

7am-3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015102

Greenberg Dental - Mandarin

10601 San Jose Blvd, Ste 117

Jacksonville, FL 32257

(904) 483-3027

Special Needs: Yes

M 7am - 3pm, T 10am - 6pm

W-F 7am-3pm

S 8am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015123

Greenberg Dental - Normandy

5149 Normandy Blvd, Unit 4

Jacksonville, FL 32205

(904) 781-1201

Special Needs: Yes

English

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015101

Greenberg Dental - Northside

1036 Dunn Ave Ste 42

Jacksonville, FL 32218

(904) 714-9909

Special Needs: Yes

English, Spanish

M 7am - 6pm, T 7am - 5pm

W-Th 7am-6pm

S 8am - 3pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015127

Greenberg Dental - Regency

620 Commerce Center Dr Unit 155

Jacksonville, FL 32225

(904) 483-3022

Special Needs: Yes

Spanish

M 10am - 6pm, T 7am - 3pm

W-F 7am-3pm

S 8am - 3pm

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015107

Greenberg Dental - San Pablo

14444 Beach Blvd, Ste 2

Jacksonville, FL 32250

(904) 223-4939

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-Th 8am-4pm

S 8am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015126

Greenberg Dental -

University-Jacksonville

5937 University Blvd W.

Jacksonville, FL 32216

(904) 730-4150

Special Needs: Yes

Spanish, French

M 9am - 5pm, T 7am - 3pm

W-F 7am-3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#010603

Greenberg Dental & Orthodontics

10095 Beach Blvd, Ste 150

Jacksonville, FL 32246

(904) 647-2050

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 10am - 6pm

Th-F 7am-3pm

S 8am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#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

ORTHODONTIST

#015100

Greenberg Dental - Atlantic Beach

1023 Atlantic Blvd

Atlantic Beach, FL 32233

(904) 249-3104

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-F 7am-3pm

S 8am - 4pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015106

Greenberg Dental - Bartram Park

13820 Old St. Augustine Rd, Ste 105

Jacksonville, FL 32258

(904) 260-7700

Special Needs: Yes

English, Russian, Spanish

M-T 7am-6pm

W 7am-7pm, Th 7am-4pm,F 7am-3pm

S 8am - 1pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015136

Greenberg Dental - Baymeadows

9978 Old Baymeadows Rd, Ste 1

Jacksonville, FL 32256

(904) 645-5015

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

S 8am - 2pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015122

Greenberg Dental - Blanding

5116 Blanding Blvd

Jacksonville, FL 32210

(904) 573-7900

Special Needs: Yes

Spanish

M 9am - 5pm, T 7am - 3pm

W 7am-3pm, Th 3pm-7pm,F

7am-3pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015102

Greenberg Dental - Mandarin

10601 San Jose Blvd, Ste 117

Jacksonville, FL 32257

(904) 483-3027

Special Needs: Yes

M 7am - 3pm, T 10am - 6pm

W-F 7am-3pm

S 8am - 2pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015123

Greenberg Dental - Normandy

5149 Normandy Blvd, Unit 4

Jacksonville, FL 32205

(904) 781-1201

Special Needs: Yes

English

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015101

Greenberg Dental - Northside

1036 Dunn Ave Ste 42

Jacksonville, FL 32218

(904) 714-9909

Special Needs: Yes

English, Spanish

M 7am - 6pm, T 7am - 5pm

W-Th 7am-6pm

S 8am - 3pm

# DN18750 Bouvier, Amy

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015127

Greenberg Dental - Regency

620 Commerce Center Dr Unit 155

Jacksonville, FL 32225

(904) 483-3022

Special Needs: Yes

Spanish

M 10am - 6pm, T 7am - 3pm

W-F 7am-3pm

S 8am - 3pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015107

Greenberg Dental - San Pablo

14444 Beach Blvd, Ste 2

Jacksonville, FL 32250

(904) 223-4939

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-Th 8am-4pm

S 8am - 2pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#015126

Greenberg Dental -

University-Jacksonville

5937 University Blvd W.

Jacksonville, FL 32216

(904) 730-4150

Special Needs: Yes

Spanish, French

M 9am - 5pm, T 7am - 3pm

W-F 7am-3pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#010603

Greenberg Dental & Orthodontics

10095 Beach Blvd, Ste 150

Jacksonville, FL 32246

(904) 647-2050

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 10am - 6pm

Th-F 7am-3pm

S 8am - 2pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#018489

Greenberg Dental & Orthodontics

11043 Crystal Springs Rd Ste 20

Jacksonville, FL 32221

(904) 236-6250

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

Th-F 8am-4pm

# DN21116 Lipkin, Julia

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

#011898

Jacksonville Orthodontics

1190 Edgewood Ave W Ste A

Jacksonville, FL 32208

www.jacksonvilleorthodontics.net

(904) 766-6000

Special Needs: Yes

English

M-T 7am-5pm

W-Th 7am-5pm

# DN6224 Mitchell, Orrin

NPI: 1487736567 LIC: DN6224

CERTIFICATIONS :

• Board Certification

#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

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#010846

Great Expressions Dental Centers

3706 Blanding Blvd

Jacksonville, FL 32210

(904) 777-1477

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18619 Kuhl, Philip

NPI: 1265668586 LIC: DN18619

CERTIFICATIONS :

• Inhalation Sedation

#010856

Great Expressions Dental Centers

3714 Heath Road

Jacksonville, FL 32277

(904) 302-7552

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN18619 Kuhl, Philip

NPI: 1265668586 LIC: DN18619

CERTIFICATIONS :

• Inhalation Sedation

#014135

Great Expressions Dental Centers

9000 Golfside Dr Ste A

Jacksonville, FL 32256

(904) 737-8410

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN23234 Cummings, Marloin

NPI: 1467545087 LIC: DN23234

CERTIFICATIONS :

#015100

Greenberg Dental - Atlantic Beach

1023 Atlantic Blvd

Atlantic Beach, FL 32233

(904) 249-3104

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-F 7am-3pm

S 8am - 4pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015106

Greenberg Dental - Bartram Park

13820 Old St. Augustine Rd, Ste 105

Jacksonville, FL 32258

(904) 260-7700

Special Needs: Yes

English, Russian, Spanish

M-T 7am-6pm

W 7am-7pm, Th 7am-4pm,F 7am-3pm

S 8am - 1pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015136

Greenberg Dental - Baymeadows

9978 Old Baymeadows Rd, Ste 1

Jacksonville, FL 32256

(904) 645-5015

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

S 8am - 2pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015122

Greenberg Dental - Blanding

5116 Blanding Blvd

Jacksonville, FL 32210

(904) 573-7900

Special Needs: Yes

Spanish

M 9am - 5pm, T 7am - 3pm

W 7am-3pm, Th 3pm-7pm,F

7am-3pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015102

Greenberg Dental - Mandarin

10601 San Jose Blvd, Ste 117

Jacksonville, FL 32257

(904) 483-3027

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Special Needs: Yes

M 7am - 3pm, T 10am - 6pm

W-F 7am-3pm

S 8am - 2pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015123

Greenberg Dental - Normandy

5149 Normandy Blvd, Unit 4

Jacksonville, FL 32205

(904) 781-1201

Special Needs: Yes

English

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015101

Greenberg Dental - Northside

1036 Dunn Ave Ste 42

Jacksonville, FL 32218

(904) 714-9909

Special Needs: Yes

English, Spanish

M 7am - 6pm, T 7am - 5pm

W-Th 7am-6pm

S 8am - 3pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015127

Greenberg Dental - Regency

620 Commerce Center Dr Unit 155

Jacksonville, FL 32225

(904) 483-3022

Special Needs: Yes

Spanish

M 10am - 6pm, T 7am - 3pm

W-F 7am-3pm

S 8am - 3pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015107

Greenberg Dental - San Pablo

14444 Beach Blvd, Ste 2

Jacksonville, FL 32250

(904) 223-4939

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-Th 8am-4pm

S 8am - 2pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#015126

Greenberg Dental -

University-Jacksonville

5937 University Blvd W.

Jacksonville, FL 32216

(904) 730-4150

Special Needs: Yes

Spanish, French

M 9am - 5pm, T 7am - 3pm

W-F 7am-3pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#010603

Greenberg Dental & Orthodontics

10095 Beach Blvd, Ste 150

Jacksonville, FL 32246

(904) 647-2050

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 10am - 6pm

Th-F 7am-3pm

S 8am - 2pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#018489

Greenberg Dental & Orthodontics

11043 Crystal Springs Rd Ste 20

Jacksonville, FL 32221

(904) 236-6250

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

Th-F 8am-4pm

# DN15103 Bennett, James

NPI: 1902216153 LIC: DN15103

CERTIFICATIONS :

#011965

Kids First Dentistry

4495 Roosevelt Blvd, Ste 111

Jacksonville, FL 32210

kids1dentistry.com

(904) 423-1377

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN13919 Mahajan, Jila

NPI: 1518369115 LIC: DN13919

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious 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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#011380

Richard W. Blake DDS PA

943 Cesery Blvd, #D

Jacksonville, FL 32211

(904) 743-2000

Special Needs: Yes

English

M-T 8am-4pm

W 8am-4pm, Th 8am-12pm

# DN5634 Blake, Richard

NPI: 1912921867 LIC: DN5634

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

PERIODONTICS

#015100

Greenberg Dental - Atlantic Beach

1023 Atlantic Blvd

Atlantic Beach, FL 32233

(904) 249-3104

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-F 7am-3pm

S 8am - 4pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015106

Greenberg Dental - Bartram Park

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

13820 Old St. Augustine Rd, Ste 105

Jacksonville, FL 32258

(904) 260-7700

Special Needs: Yes

English, Russian, Spanish

M-T 7am-6pm

W 7am-7pm, Th 7am-4pm,F 7am-3pm

S 8am - 1pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015136

Greenberg Dental - Baymeadows

9978 Old Baymeadows Rd, Ste 1

Jacksonville, FL 32256

(904) 645-5015

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

S 8am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015122

Greenberg Dental - Blanding

5116 Blanding Blvd

Jacksonville, FL 32210

(904) 573-7900

Special Needs: Yes

Spanish

M 9am - 5pm, T 7am - 3pm

W 7am-3pm, Th 3pm-7pm,F

7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015102

Greenberg Dental - Mandarin

10601 San Jose Blvd, Ste 117

Jacksonville, FL 32257

(904) 483-3027

Special Needs: Yes

M 7am - 3pm, T 10am - 6pm

W-F 7am-3pm

S 8am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015123

Greenberg Dental - Normandy

5149 Normandy Blvd, Unit 4

Jacksonville, FL 32205

(904) 781-1201

Special Needs: Yes

English

M 10am - 6pm, T 8am - 4pm

W-Th 8am-4pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015101

Greenberg Dental - Northside

1036 Dunn Ave Ste 42

Jacksonville, FL 32218

(904) 714-9909

Special Needs: Yes

English, Spanish

M 7am - 6pm, T 7am - 5pm

W-Th 7am-6pm

S 8am - 3pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015127

Greenberg Dental - Regency

620 Commerce Center Dr Unit 155

Jacksonville, FL 32225

(904) 483-3022

Special Needs: Yes

Spanish

M 10am - 6pm, T 7am - 3pm

W-F 7am-3pm

S 8am - 3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015107

Greenberg Dental - San Pablo

14444 Beach Blvd, Ste 2

Jacksonville, FL 32250

(904) 223-4939

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-Th 8am-4pm

S 8am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015126

Greenberg Dental -

University-Jacksonville

5937 University Blvd W.

Jacksonville, FL 32216

(904) 730-4150

Special Needs: Yes

Spanish, French

M 9am - 5pm, T 7am - 3pm

W-F 7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#010603

Greenberg Dental & Orthodontics

10095 Beach Blvd, Ste 150

Jacksonville, FL 32246

(904) 647-2050

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 10am - 6pm

Th-F 7am-3pm

S 8am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#018489

Greenberg Dental & Orthodontics

11043 Crystal Springs Rd Ste 20

Jacksonville, FL 32221

(904) 236-6250

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

Th-F 8am-4pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious 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

# 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

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 :

#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 :

# DN19082 Hernandez, Gabriel

NPI: 1093956088 LIC: DN19082

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#022465

Victus Dental II PA

1308 West 9 Mile Road, Ste 9

Pensacola, FL 32534

(850) 484-4844

Special Needs: Yes

English, Spanish

M 8am - 6pm,

W 8am-6pm,

# DN18764 Brennan, Vanessa

NPI: 1336378603 LIC: DN18764

CERTIFICATIONS :

# DN20335 Le, Anthony

NPI: 1366875221 LIC: DN20335

CERTIFICATIONS :

• Inhalation Sedation

#016793

Victus Dental, PA

2850 Monroe Street

Pensacola, FL 32514

(850) 484-4844

Special Needs: Yes

English, Vietnamese

M-T 8am-6pm

W-Th 8am-6pm

# DN18764 Brennan, Vanessa

NPI: 1336378603 LIC: DN18764

CERTIFICATIONS :

# DN20335 Le, Anthony

NPI: 1366875221 LIC: DN20335

CERTIFICATIONS :

• Inhalation Sedation

ORTHODONTIST

#019093

Fishbein Orthodontics

4900 Marketplace Rd

Pensacola, FL 32504

(850) 477-1089

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN22677 De Moya, Adrian

NPI: 1790259372 LIC: DN22677

CERTIFICATIONS :

# DN18812 Fishbein, Benjamin

NPI: 1144543620 LIC: DN18812

CERTIFICATIONS :

# DN22495 Howle, Sarah

NPI: 1215477146 LIC: DN22495

CERTIFICATIONS :

# DN18855 Rezaie, Maryam

NPI: 1467781443 LIC: DN18855

CERTIFICATIONS :

#019097

Fishbein Orthodontics

12385 Sorrento Rd, Ste C2

Pensacola, FL 32507

wwwemeraldcoastbraces.com

(850) 477-1089

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN22677 De Moya, Adrian

NPI: 1790259372 LIC: DN22677

CERTIFICATIONS :

# DN18812 Fishbein, Benjamin

NPI: 1144543620 LIC: DN18812

CERTIFICATIONS :

# DN22495 Howle, Sarah

NPI: 1215477146 LIC: DN22495

CERTIFICATIONS :

# DN18855 Rezaie, Maryam

NPI: 1467781443 LIC: DN18855

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 :

#017728

Greenberg Dental & Orthodontics

50 Plaza Dr Ste 201

Palm Coast, FL 32137

(386) 516-0751

Special Needs: Yes

M-T 10am-6pm

W-Th 8am-4pm

S 8am - 2pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#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 :

ENDODONTICS

#017728

Greenberg Dental & Orthodontics

50 Plaza Dr Ste 201

Palm Coast, FL 32137

(386) 516-0751

Special Needs: Yes

M-T 10am-6pm

W-Th 8am-4pm

S 8am - 2pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

ORAL SURGEON

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

PEDIATRIC DENTISTRY

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

PERIODONTICS

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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 :

GILCHRIST COUNTY

DENTIST

#CHC015359

DOH - Gilchrist County Health

Department

119 Ne 1St St

Trenton, FL 32693

(352) 463-3120

Special Needs: Yes

English

M-T 8am-5pm

W 8am-5pm,

# DN15416 Elam, Christine

NPI: 1922136092 LIC: DN15416

CERTIFICATIONS :

# DN14796 Turner, David

NPI: 1679894257 LIC: DN14796

CERTIFICATIONS :

#FQHC012458

Palms Medical Group

911 South Main St

Trenton, FL 32693

www.palmsmg.org

(352) 463-4526

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN9869 Jones, Stanley

NPI: 1528162047 LIC: DN9869

CERTIFICATIONS :

# DN22911 Koubek, Catherine

NPI: 1730619594 LIC: DN22911

CERTIFICATIONS :

• Inhalation Sedation

# DN24208 Lima, Pamela

NPI: 1982264438 LIC: DN24208

CERTIFICATIONS :

# DN20927 Rooney, Matthew

NPI: 1598165532 LIC: DN20927

CERTIFICATIONS :

• Inhalation Sedation

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

HAMILTON COUNTY

DENTIST

#010952

Jerry B. Smith, Jr. DMD

1133 4Th Street Nw

Jasper, FL 32052

(386) 792-1197

Special Needs: Yes

English

T 8am - 5pm

W-F 8am-5pm

# DN8071 Smith Jr., Jerry

NPI: 1659393916 LIC: DN8071

CERTIFICATIONS :

• Inhalation Sedation

HARDEE COUNTY

DENTIST

#FQHC010736

Central Florida Health Care Inc

121 Kd Revell Rd

Wauchula, FL 33873

(863) 767-0696

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 :

# DN17405 Ward, Tasha

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

#CHC10021

DOH - Hardee 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 61 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

115 K. D. Revell Road

Wauchula, FL 33873

(863) 773-4161

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN11009 Ebner, Stephen

NPI: 1578652442 LIC: DN11009

CERTIFICATIONS :

• Inhalation Sedation

PEDIATRIC DENTISTRY

#FQHC010736

Central Florida Health Care Inc

121 Kd Revell Rd

Wauchula, FL 33873

(863) 767-0696

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

M-T 7am-5pm

W-F 7am-5pm

# DN23280 Polanco, Alejandra

NPI: 1487181541 LIC: DN23280

CERTIFICATIONS :

• Inhalation Sedation

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 :

#FQHC010641

Family Health Centers of

Southwest Florida, Inc.

930 S. Main St

Labelle, FL 33935

www.fhcswf.org

(863) 675-0387

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

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

#011121

Akel Dental LLC

5445 Commercial Way

Spring Hill, FL 34606

(352) 596-9900

Special Needs: Yes

English

M-T 9am-5pm

# DN18012 Akel, Amir

NPI: 1477716801 LIC: DN18012

CERTIFICATIONS :

#021785

Children and Teen Dental Group

of Florida

5456 Spring Hill Drive

Spring Hill, FL 34606

(352) 666-1400

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN16260 Adewunmi, Mopelola

NPI: 1477605053 LIC: DN16260

CERTIFICATIONS :

• Inhalation Sedation

# DN20260 Chang, Steven

NPI: 1649611799 LIC: DN20260

CERTIFICATIONS :

• Inhalation Sedation

# DN19041 Chapagain, Shweta

NPI: 1346561396 LIC: DN19041

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 62 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN16308 Dao, Thieu

NPI: 1881810158 LIC: DN16308

CERTIFICATIONS :

• Inhalation Sedation

# DN23038 Hernandez, Christine

NPI: 1891216784 LIC: DN23038

CERTIFICATIONS :

• Inhalation Sedation

# DN13761 Mauricio, Margaret

NPI: 1558354209 LIC: DN13761

CERTIFICATIONS :

• Inhalation Sedation

# DN22068 Paula, Kelly

NPI: 1487107470 LIC: DN22068

CERTIFICATIONS :

• Inhalation Sedation

# DN15728 Pham, Nguyen

NPI: 1750483434 LIC: DN15728

CERTIFICATIONS :

• Inhalation Sedation

# DN15319 Pham, Thanh

NPI: 1700947660 LIC: DN15319

CERTIFICATIONS :

• Inhalation Sedation

# DN16447 Siemiet, Erika

NPI: 1770709057 LIC: DN16447

CERTIFICATIONS :

• Inhalation Sedation

# DN22093 St Charles II, Jay

NPI: 1336591452 LIC: DN22093

CERTIFICATIONS :

• Inhalation Sedation

#018188

Lil' Teeth by Oloph

17040 Ayers Road

Brooksville, FL 34604

(352) 593-0545

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN14994 Berk, Lars

NPI: 1336251487 LIC: DN14994

CERTIFICATIONS :

# DN15318 Berk, Madeline

NPI: 1588623094 LIC: DN15318

CERTIFICATIONS :

• Inhalation Sedation

#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 :

PEDIATRIC DENTISTRY

#021785

Children and Teen Dental Group

of Florida

5456 Spring Hill Drive

Spring Hill, FL 34606

(352) 666-1400

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN12365 Montgomery, Nancy

NPI: 1538200282 LIC: DN12365

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#010037

Smile Design Spring Hill

1406 Pinehurst Drive

Spring Hill, FL 34606

(352) 686-1007

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-5pm, Th 7am-5pm,F 8am-5pm

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

HIGHLANDS COUNTY

DENTIST

#CHC7920

Central Florida Health Care

950 County Road 17-A West

Avon Park, FL 33825

(863) 452-3050

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

#013937

Akel Dental of Tampa PLLC

2727 W. Martin Luther King Jr. Ste

120

Tampa, FL 33607

(813) 873-9100

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18012 Akel, Amir

NPI: 1477716801 LIC: DN18012

CERTIFICATIONS :

#FQHC014288

Brandon Community Health

Centers

313 S. Lakewood Dr

Brandon, FL 33511

(813) 349-7907

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 :

#022643

Brandon Family Dental Care, LLC

227 N Knights Ave

Brandon, FL 33510

(813) 685-5611

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN12116 Mason, John

NPI: 1851370456 LIC: DN12116

CERTIFICATIONS :

# DN11501 Parker, David

NPI: 1235255845 LIC: DN11501

CERTIFICATIONS :

#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 :

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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 :

#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 :

#011102

Complete Dental Care, PA

11213 N. Nebraska Ave, Ste # 406C

Tampa, FL 33612

(813) 977-4819

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN12708 Hannah-Jones, Kimberly

NPI: 1881938850 LIC: DN12708

CERTIFICATIONS :

• Inhalation Sedation

#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 :

#007673

Dr. Mukesh Kapadia

613 West Martin Luther King Bldv,

Ste #103

Tampa, FL 33603

(813) 237-2882

Special Needs: No

English, Spanish, Hindi,

Indo-European(other)

M-T 9am-5pm

Th-F 9am-5pm

S 11am - 2pm

# DN10771 Kapadia, Mukesh

NPI: 1689717134 LIC: DN10771

CERTIFICATIONS :

#011410

E.L. Moore DDS, PA

6702 North Armenia Ave

Tampa, FL 33604

(813) 932-0458

Special Needs: No

English, Spanish

M-T 9am-5pm

W 9am-5pm,

S 7am - 2pm

# DN10803 Moore, Edith

NPI: 1386613578 LIC: DN10803

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 65 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#011165

East Tampa Dental

4802 E. 7Th Ave

Tampa, FL 33605

(813) 248-8515

Special Needs: No

English, Spanish

W 9am-3pm,

S 9am - 12pm

# DN14205 Melean, Alfonso

NPI: 1609845031 LIC: DN14205

CERTIFICATIONS :

#010844

Great Expressions Dental Centers

13146 Us Hwy 301 S

Riverview, FL 33578

(813) 672-9575

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23341 Allawnha, Abdullah

NPI: 1558852392 LIC: DN23341

CERTIFICATIONS :

# DN24345 Baez, Dayron

NPI: 1578125431 LIC: DN24345

CERTIFICATIONS :

# DN20636 Gagnon, Robyn

NPI: 1679986020 LIC: DN20636

CERTIFICATIONS :

# DN13315 Rodenbostel, Peter

NPI: 1790822930 LIC: DN13315

CERTIFICATIONS :

# DN13640 Schaffner, Daniel

NPI: 1548339815 LIC: DN13640

CERTIFICATIONS :

• Inhalation Sedation

# DN20669 Spouh, Mohammad

NPI: 1902210842 LIC: DN20669

CERTIFICATIONS :

# DN19801 Wheeley, Amrita

NPI: 1649533605 LIC: DN19801

CERTIFICATIONS :

#010845

Great Expressions Dental Centers

10845 Bloomingdale Ave

Riverview, FL 33578

(813) 662-6100

Special Needs: Yes

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

# DN21353 Arora, Payal

NPI: 1356723407 LIC: DN21353

CERTIFICATIONS :

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN21523 Cardenas, Astrid

NPI: 1962831644 LIC: DN21523

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN22711 Rivadeneira, Jose

NPI: 1376063313 LIC: DN22711

CERTIFICATIONS :

# DN13640 Schaffner, Daniel

NPI: 1548339815 LIC: DN13640

CERTIFICATIONS :

• Inhalation Sedation

# DN20669 Spouh, Mohammad

NPI: 1902210842 LIC: DN20669

CERTIFICATIONS :

#010847

Great Expressions Dental Centers

15148 N. Dale Mabry Hwy

Tampa, FL 33618

(813) 960-0106

Special Needs: Yes

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN16153 Karthik, Aneetha

NPI: 1295877470 LIC: DN16153

CERTIFICATIONS :

# DN16023 Martinez, Pedro

NPI: 1487705307 LIC: DN16023

CERTIFICATIONS :

#010853

Great Expressions Dental Centers

5658 Fishhawk Crossing Blvd

Lithia, FL 33547

(813) 490-1982

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 7am-4pm

# DN22775 Bala, Joanna

NPI: 1144743774 LIC: DN22775

CERTIFICATIONS :

# DN20636 Gagnon, Robyn

NPI: 1679986020 LIC: DN20636

CERTIFICATIONS :

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN24319 Lee, Vera

NPI: 1326271842 LIC: DN24319

CERTIFICATIONS :

#010863

Great Expressions Dental Centers

1060 West Busch Blvd, Ste 105

Tampa, FL 33612

(813) 931-4000

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN22775 Bala, Joanna

NPI: 1144743774 LIC: DN22775

CERTIFICATIONS :

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN16023 Martinez, Pedro

NPI: 1487705307 LIC: DN16023

CERTIFICATIONS :

# DN16578 Morelli, Karen

NPI: 1376758961 LIC: DN16578

CERTIFICATIONS :

# DN13315 Rodenbostel, Peter

NPI: 1790822930 LIC: DN13315

CERTIFICATIONS :

# DN9001 Tannen, Mildred

NPI: 1285858415 LIC: DN9001

CERTIFICATIONS :

# DN22634 Weaver, Damone

NPI: 1134658818 LIC: DN22634

CERTIFICATIONS :

#010867

Great Expressions Dental Centers

2468 W. Brandon Blvd

Brandon, FL 33511

(813) 654-6700

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN21523 Cardenas, Astrid

NPI: 1962831644 LIC: DN21523

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN22776 Maduro, Ledesha

NPI: 1174982458 LIC: DN22776

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 66 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN23932 Phu, Lesley

NPI: 1851870596 LIC: DN23932

CERTIFICATIONS :

# DN13640 Schaffner, Daniel

NPI: 1548339815 LIC: DN13640

CERTIFICATIONS :

• Inhalation Sedation

#010869

Great Expressions Dental Centers

13022 Racetrack Rd, Ste 101

Tampa, FL 33626

(813) 814-1868

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN22306 Brattain, Andrew

NPI: 1326599168 LIC: DN22306

CERTIFICATIONS :

• Inhalation Sedation

# DN12680 Dos Passos II, John

NPI: 1265411953 LIC: DN12680

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN20669 Spouh, Mohammad

NPI: 1902210842 LIC: DN20669

CERTIFICATIONS :

# DN19801 Wheeley, Amrita

NPI: 1649533605 LIC: DN19801

CERTIFICATIONS :

#010984

Great Expressions Dental Centers

6552 Gunn Hwy

Tampa, FL 33625

(813) 963-0307

Special Needs: Yes

English, Spanish

M-T 10am-7pm

W-F 8am-5pm

# DN21353 Arora, Payal

NPI: 1356723407 LIC: DN21353

CERTIFICATIONS :

# DN23272 Chheda, Sonia

NPI: 1821519091 LIC: DN23272

CERTIFICATIONS :

# DN21770 Commedore, Chanelle

NPI: 1831581693 LIC: DN21770

CERTIFICATIONS :

# DN12680 Dos Passos II, John

NPI: 1265411953 LIC: DN12680

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

#010988

Great Expressions Dental Centers

10924 Cross Creek Blvd

Tampa, FL 33647

(813) 982-1777

Special Needs: Yes

English, Russian

M-T 8am-5pm

W-F 8am-5pm

# DN20562 Decambra, Nicole

NPI: 1790125821 LIC: DN20562

CERTIFICATIONS :

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

#010990

Great Expressions Dental Centers

114 N. 12Th St

Tampa, FL 33602

(813) 223-3266

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20636 Gagnon, Robyn

NPI: 1679986020 LIC: DN20636

CERTIFICATIONS :

# DN22711 Rivadeneira, Jose

NPI: 1376063313 LIC: DN22711

CERTIFICATIONS :

# DN19801 Wheeley, Amrita

NPI: 1649533605 LIC: DN19801

CERTIFICATIONS :

#010991

Great Expressions Dental Centers

5101 E. Busch Blvd, Ste #13

Tampa, FL 33617

(813) 988-1167

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN22775 Bala, Joanna

NPI: 1144743774 LIC: DN22775

CERTIFICATIONS :

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN22509 Kamdem, Elodie

NPI: 1730548934 LIC: DN22509

CERTIFICATIONS :

# DN15142 Reed, Samantha

NPI: 1104042456 LIC: DN15142

CERTIFICATIONS :

• Inhalation Sedation

# DN13315 Rodenbostel, Peter

NPI: 1790822930 LIC: DN13315

CERTIFICATIONS :

#011011

Great Expressions Dental Centers

4333 W. Bay To Bay Blvd

Tampa, FL 33629

(813) 837-5147

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-5pm

# DN22578 Healey, Kristyn

NPI: 1619401205 LIC: DN22578

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN23932 Phu, Lesley

NPI: 1851870596 LIC: DN23932

CERTIFICATIONS :

# DN20669 Spouh, Mohammad

NPI: 1902210842 LIC: DN20669

CERTIFICATIONS :

# DN19801 Wheeley, Amrita

NPI: 1649533605 LIC: DN19801

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

# 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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#011014

Great Expressions Dental Centers

1620 State Road 60 , Ste E

Valrico, FL 33594

(813) 681-4874

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 9am-6pm

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

#016186

Great Expressions Dental Centers

3806 W. Linebaugh Ave

Tampa, FL 33618

(813) 960-0917

Special Needs: No

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN15142 Reed, Samantha

NPI: 1104042456 LIC: DN15142

CERTIFICATIONS :

• Inhalation Sedation

#011222

Gredell Hernandez, DDS

2509 West Crest Ave, Ste #4

Tampa, FL 33614

(813) 877-4638

Special Needs: No

English, Spanish

M-T 9am-5pm

W 8am-4pm, Th 9am-5pm

# DN13251 Hernandez, Gredell

NPI: 1770654238 LIC: DN13251

CERTIFICATIONS :

• Inhalation Sedation

#010391

Greenberg Dental & Orthodontics

3942 Britton Plz

Tampa, FL 33611

(813) 365-3024

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#010392

Greenberg Dental & Orthodontics

2702 W. Hillsborough Ave

Tampa, FL 33614

(813) 365-3021

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#010579

Greenberg Dental & Orthodontics

234 E. Bearss Ave

Tampa, FL 33613

(813) 337-6353

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 11am - 7pm

W-Th 8am-4pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

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 69 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#013936

Greenberg Dental & Orthodontics

9618 Us Hwy 301 S

Riverview, FL 33578

(813) 867-7062

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#015210

Greenberg Dental & Orthodontics

8851 N. 56Th St

Temple Terrace, FL 33617

(813) 381-5628

Special Needs: Yes

Spanish, Portuguese

M-T 7am-4pm

W-Th 10am-6pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#015441

Greenberg Dental & Orthodontics

12030 Anderson Rd

Tampa, FL 33625

(813) 381-5646

Special Needs: Yes

Spanish

M 7am - 3pm, T 11am - 7pm

W 11am-7pm, Th 7am-3pm,F

7am-2pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#021732

Greenberg Dental & Orthodontics

111 W. Alexander Street

Plant City, FL 33563

(813) 708-6732

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN21530 Bradley, Ashley

NPI: 1962862003 LIC: DN21530

CERTIFICATIONS :

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#012052

Greenberg Dental & Orthodontics

10041 W. Hillsborough Ave

Tampa, FL 33615

(813) 235-0957

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

S 7am - 2pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#015277

Greenberg Dental- Brandon

511 W. Brandon Blvd

Brandon, FL 33511

(813) 381-5632

Special Needs: No

Spanish

M 10am - 6pm, T 8am - 4pm

W 10am-6pm, Th 8am-4pm,F

7am-3pm

S 8am - 3pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

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 73 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

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

NPI: 1780125716 LIC: DN23107

CERTIFICATIONS :

• Inhalation Sedation

# DN23694 Yglesias Ruiz, Erick

NPI: 1427534239 LIC: DN23694

CERTIFICATIONS :

• Inhalation Sedation

#007987

Happy Kids Pediatric Dentistry

7715 W. Hillsborough Ave

Tampa, FL 33615

(813) 887-5437

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 9am-4pm

W-Th 9am-4pm

# DN18618 Alvarez, Juan

NPI: 1831326974 LIC: DN18618

CERTIFICATIONS :

• Inhalation Sedation

# DN18899 Botero, Catalina

NPI: 1659513380 LIC: DN18899

CERTIFICATIONS :

• Inhalation Sedation

# DN23694 Yglesias Ruiz, Erick

NPI: 1427534239 LIC: DN23694

CERTIFICATIONS :

• Inhalation Sedation

#014308

Juan L. Alvarez DDS PA

11758 Dr Martin Luther King Jr Blvd

Seffner, FL 33584

(813) 651-9411

Special Needs: No

English, Spanish

M 8am - 5pm,

W 8am-5pm,

# DN18618 Alvarez, Juan

NPI: 1831326974 LIC: DN18618

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1033208392 LIC: DN15969

CERTIFICATIONS :

• Inhalation Sedation

#011224

KidZone Dentistry

13127 Kings Lake Drive, Ste 101

Gibsonton, FL 33534

(813) 677-3047

Special Needs: Yes

English, Arabic, French, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN18156 Garcia, Eric

NPI: 1952566341 LIC: DN18156

CERTIFICATIONS :

• Inhalation Sedation

#023045

Li'l Sunshine Smiles Dentistry PA

12950 Racetrack Road, Ste 109

Tampa, FL 33626

(813) 803-3355

Special Needs: Yes

English, Spanish

M 8am - 5pm, T 9am - 6pm

W 8am-5pm, Th 10am-7pm,F

8am-5pm

# DN18899 Botero, Catalina

NPI: 1659513380 LIC: DN18899

CERTIFICATIONS :

• Inhalation Sedation

#011170

Mapledale Dental

15711 Mapledale Blvd

Tampa, FL 33624

(813) 264-1600

Special Needs: No

English, Spanish

M-T 8am-4pm

W 8am-4pm, Th 8am-1pm

# DN12772 Ponce, Rolando*

NPI: 1841213808 LIC: DN12772

CERTIFICATIONS :

#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 :

#011089

Pedro A. Belaunzaran, DDS. P.A.

& Assc.

8130 W. Waters Ave, Ste 200-B

Tampa, FL 33615

(813) 243-4142

Special Needs: No

English, Arabic

M-T 9am-6pm

W-F 9am-6pm

# DN13554 Belaunzaran, Pedro

NPI: 1164513610 LIC: DN13554

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 :

# DN18142 Johnson, Jonathan*

NPI: 1144207838 LIC: DN18142

CERTIFICATIONS :

# DN14756 Lee-Loy, Ingrid*

NPI: 1144292236 LIC: DN14756

CERTIFICATIONS :

# DN10403 Valdez, Harvey*

NPI: 1548325491 LIC: DN10403

CERTIFICATIONS :

#EV265681

Playa Family Dentistry

4340 W Hillsborough Ave Ste 702

Tampa, FL 33614

(813) 445-3240

Special Needs: No

English, Spanish

M-T 10am-6pm

W-F 10am-6pm

S 10am - 3pm

# DN21658FL Simon, Keith

NPI: 1457748154 LIC: DN21658FL

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

#014286

Skylight Dental Care PLLC

117 N. Oakwood Ave

Brandon, FL 33510

(813) 530-0991

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN19426 Abreu, Edward

NPI: 1679860407 LIC: DN19426

CERTIFICATIONS :

# DN19212 Espinal, Licette

NPI: 1629378203 LIC: DN19212

CERTIFICATIONS :

• Inhalation Sedation

#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 :

# 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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(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

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

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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 :

#011111

Westwood Family Dental Center

8573 W. Linebaugh Ave

Tampa, FL 33625

www.westwooddentalspa.com

(813) 852-2007

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W 8am-4pm, Th 9am-4pm,F 8am-4pm

# DN17092 Lopez, Kenia

NPI: 1992938328 LIC: DN17092

CERTIFICATIONS :

• Inhalation Sedation

# DN15142 Reed, Samantha

NPI: 1104042456 LIC: DN15142

CERTIFICATIONS :

• Inhalation Sedation

# DN22825 Seaver, Neil

NPI: 1700308855 LIC: DN22825

CERTIFICATIONS :

• Inhalation Sedation

# DN15886 Vergara, Claudia

NPI: 1043266505 LIC: DN15886

CERTIFICATIONS :

• Inhalation Sedation

ENDODONTICS

#012708

Duro Oguntebi, DDS MSD

110 N Armenia Ave Ste B

Tampa, FL 33609

(813) 254-0041

Special Needs: Yes

English

M-T 8am-5pm

W 8am-2pm, Th 8am-5pm,F 8am-2pm

# DN13140 Oguntebi, Bamiduro

NPI: 1942434642 LIC: DN13140

CERTIFICATIONS :

#012709

Duro Oguntebi, DDS MSD

623 E. Alexander Ave

Plant City, FL 33563

(813) 254-0041

Special Needs: Yes

English

T 9am - 3pm

# DN13140 Oguntebi, Bamiduro

NPI: 1942434642 LIC: DN13140

CERTIFICATIONS :

#014640

Endodontic Innovations

13127 Kings Lake Dr, Ste 101

Gibsonton, FL 33534

endodonticinnovations.com

(813) 284-7958

Special Needs: Yes

English, Spanish, Vietnamese

T 9am - 5pm

# DN18558 Pham, Thai

NPI: 1215261581 LIC: DN18558

CERTIFICATIONS :

• Inhalation Sedation

#010391

Greenberg Dental & Orthodontics

3942 Britton Plz

Tampa, FL 33611

(813) 365-3024

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#010392

Greenberg Dental & Orthodontics

2702 W. Hillsborough Ave

Tampa, FL 33614

(813) 365-3021

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#010579

Greenberg Dental & Orthodontics

234 E. Bearss Ave

Tampa, FL 33613

(813) 337-6353

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 11am - 7pm

W-Th 8am-4pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#013936

Greenberg Dental & Orthodontics

9618 Us Hwy 301 S

Riverview, FL 33578

(813) 867-7062

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#015210

Greenberg Dental & Orthodontics

8851 N. 56Th St

Temple Terrace, FL 33617

(813) 381-5628

Special Needs: Yes

Spanish, Portuguese

M-T 7am-4pm

W-Th 10am-6pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#015441

Greenberg Dental & Orthodontics

12030 Anderson Rd

Tampa, FL 33625

(813) 381-5646

Special Needs: Yes

Spanish

M 7am - 3pm, T 11am - 7pm

W 11am-7pm, Th 7am-3pm,F

7am-2pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#012052

Greenberg Dental & Orthodontics

10041 W. Hillsborough Ave

Tampa, FL 33615

(813) 235-0957

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

S 7am - 2pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#015277

Greenberg Dental- Brandon

511 W. Brandon Blvd

Brandon, FL 33511

(813) 381-5632

Special Needs: No

Spanish

M 10am - 6pm, T 8am - 4pm

W 10am-6pm, Th 8am-4pm,F

7am-3pm

S 8am - 3pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

ORAL SURGEON

#FQHC014288

Brandon Community Health

Centers

313 S. Lakewood Dr

Brandon, FL 33511

(813) 349-7907

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19281 Guerra-Andrade, Andres*

NPI: 1669610044 LIC: DN19281

CERTIFICATIONS :

• General Anesthesia

#020259

Dr. Robert Orta D.D.S., P.A

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 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

#010391

Greenberg Dental & Orthodontics

3942 Britton Plz

Tampa, FL 33611

(813) 365-3024

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#010392

Greenberg Dental & Orthodontics

2702 W. Hillsborough Ave

Tampa, FL 33614

(813) 365-3021

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#010579

Greenberg Dental & Orthodontics

234 E. Bearss Ave

Tampa, FL 33613

(813) 337-6353

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 11am - 7pm

W-Th 8am-4pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#013936

Greenberg Dental & Orthodontics

9618 Us Hwy 301 S

Riverview, FL 33578

(813) 867-7062

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015210

Greenberg Dental & Orthodontics

8851 N. 56Th St

Temple Terrace, FL 33617

(813) 381-5628

Special Needs: Yes

Spanish, Portuguese

M-T 7am-4pm

W-Th 10am-6pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015441

Greenberg Dental & Orthodontics

12030 Anderson Rd

Tampa, FL 33625

(813) 381-5646

Special Needs: Yes

Spanish

M 7am - 3pm, T 11am - 7pm

W 11am-7pm, Th 7am-3pm,F

7am-2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#012052

Greenberg Dental & Orthodontics

10041 W. Hillsborough Ave

Tampa, FL 33615

(813) 235-0957

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

S 7am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#015277

Greenberg Dental- Brandon

511 W. Brandon Blvd

Brandon, FL 33511

(813) 381-5632

Special Needs: No

Spanish

M 10am - 6pm, T 8am - 4pm

W 10am-6pm, Th 8am-4pm,F

7am-3pm

S 8am - 3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• 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

#015967

Blue Wave Ortho Partners, PLLC

3739 W. Neptune Street

Tampa, FL 33629

(813) 968-2483

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 80 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W-F 8am-5pm

# DN21728 Cetta, Christopher

NPI: 1689893240 LIC: DN21728

CERTIFICATIONS :

#017640

Blue Wave Ortho Partners, PLLC

8313 W. Hillsborough Ave, Ste 110

Tampa, FL 33615

(813) 968-2483

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21728 Cetta, Christopher

NPI: 1689893240 LIC: DN21728

CERTIFICATIONS :

#FQHC014288

Brandon Community Health

Centers

313 S. Lakewood Dr

Brandon, FL 33511

(813) 349-7907

Special Needs: Yes

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 :

#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

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#022081

Durrett Orthodontics

11908 Sheldon Road

Tampa, FL 33626

(813) 920-1935

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN15393 Durrett, Sharon*

NPI: 1396779708 LIC: DN15393

CERTIFICATIONS :

#015931

Florida Orthodontic Associates

1773 W. Fletcher Ave

Tampa, FL 33612

(813) 968-2483

Special Needs: Yes

English, Spanish

M-T 7am-5pm

W-F 7am-5pm

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#012041

Florida Orthodontic Institute

5020 Gunn Hwy #200

Tampa, FL 33624

(813) 264-7006

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN11575 Chin, Leo

NPI: 1174731657 LIC: DN11575

CERTIFICATIONS :

• Board Certification

#012045

Florida Orthodontic Institute

16735 Fishhawk Blvd

Lithia, FL 33547

(813) 689-6389

Special Needs: Yes

English, Chinese Mandarin, Spanish

T 8am - 5pm

W 8am-5pm,

# DN11575 Chin, Leo

NPI: 1174731657 LIC: DN11575

CERTIFICATIONS :

• Board Certification

#010391

Greenberg Dental & Orthodontics

3942 Britton Plz

Tampa, FL 33611

(813) 365-3024

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#010392

Greenberg Dental & Orthodontics

2702 W. Hillsborough Ave

Tampa, FL 33614

(813) 365-3021

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

# DN20464 Guloy, Robertzon

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#010579

Greenberg Dental & Orthodontics

234 E. Bearss Ave

Tampa, FL 33613

(813) 337-6353

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 11am - 7pm

W-Th 8am-4pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#013936

Greenberg Dental & Orthodontics

9618 Us Hwy 301 S

Riverview, FL 33578

(813) 867-7062

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#015210

Greenberg Dental & Orthodontics

8851 N. 56Th St

Temple Terrace, FL 33617

(813) 381-5628

Special Needs: Yes

Spanish, Portuguese

M-T 7am-4pm

W-Th 10am-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 81 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20464 Guloy, Robertzon

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#015441

Greenberg Dental & Orthodontics

12030 Anderson Rd

Tampa, FL 33625

(813) 381-5646

Special Needs: Yes

Spanish

M 7am - 3pm, T 11am - 7pm

W 11am-7pm, Th 7am-3pm,F

7am-2pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#012052

Greenberg Dental & Orthodontics

10041 W. Hillsborough Ave

Tampa, FL 33615

(813) 235-0957

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

S 7am - 2pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#015277

Greenberg Dental- Brandon

511 W. Brandon Blvd

Brandon, FL 33511

(813) 381-5632

Special Needs: No

Spanish

M 10am - 6pm, T 8am - 4pm

W 10am-6pm, Th 8am-4pm,F

7am-3pm

S 8am - 3pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#014247

Guzman Orthodontics

6907 W. Waters Ave

Tampa, FL 33634

www.orthoguzman.com

(813) 887-5555

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 4pm

W 10am-6pm, Th 7am-4pm

# DN13659 Guzman, Ulises

NPI: 1790880912 LIC: DN13659

CERTIFICATIONS :

• Board Certification

#014772

Mann Orthodontics, PA

5103 N. Armenia Ave

Tampa, FL 33603

www.mannmadesmiles.com

(813) 877-2333

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN20141 Mann, Nicholas

NPI: 1508205139 LIC: DN20141

CERTIFICATIONS :

#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

# DN11575 Chin, Leo

NPI: 1174731657 LIC: DN11575

CERTIFICATIONS :

• Board Certification

# DN10847 Turke, Eric

NPI: 1164633483 LIC: DN10847

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

# 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

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 :

#020033

Toro Dental PLLC

5420 Webb Road, Ste D-1

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 82 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Tampa, FL 33615

(813) 886-0545

Special Needs: Yes

English, Spanish

T 8am - 5pm

# DN18437 Toro, Edgardo

NPI: 1205822723 LIC: DN18437

CERTIFICATIONS :

#018284

Valerian Orthodontics

18964 N. Dale Mabry Hwy Ste 103

Lutz, FL 33548

www.valerianorthodontics.com

(813) 591-1568

Special Needs: No

T 8am - 5pm

Th-F 8am-5pm

# DN22487 Tavakoli, Keyvan

NPI: 1285987206 LIC: DN22487

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#015967

Blue Wave Ortho Partners, PLLC

3739 W. Neptune Street

Tampa, FL 33629

(813) 968-2483

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

CERTIFICATIONS :

• Inhalation Sedation

#017640

Blue Wave Ortho Partners, PLLC

8313 W. Hillsborough Ave, Ste 110

Tampa, FL 33615

(813) 968-2483

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

CERTIFICATIONS :

• Inhalation Sedation

#FQHC014288

Brandon Community Health

Centers

313 S. Lakewood Dr

Brandon, FL 33511

(813) 349-7907

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN21749 Black, Harrison

NPI: 1750780052 LIC: DN21749

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18568 Gyles, Richard

NPI: 1942211180 LIC: DN18568

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19520 Lasanta, Denisse

NPI: 1801174131 LIC: DN19520

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# 19991FL Newcity, Amanda

NPI: 1457615668 LIC: 19991FL

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#015282

David P. Alfano, DDS

14037 N Dale Mabry Highway

Tampa, FL 33618

(813) 968-5743

Special Needs: Yes

English

M-T 7am-5pm

W-Th 7am-5pm

# DN9812 Alfano, David

NPI: 1164454831 LIC: DN9812

CERTIFICATIONS :

#010844

Great Expressions Dental Centers

13146 Us Hwy 301 S

Riverview, FL 33578

(813) 672-9575

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010845

Great Expressions Dental Centers

10845 Bloomingdale Ave

Riverview, FL 33578

(813) 662-6100

Special Needs: Yes

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

# DN15989 Jafarnia, Bahareh

NPI: 1407905730 LIC: DN15989

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010847

Great Expressions Dental Centers

15148 N. Dale Mabry Hwy

Tampa, FL 33618

(813) 960-0106

Special Needs: Yes

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN15989 Jafarnia, Bahareh

NPI: 1407905730 LIC: DN15989

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21471 Monteleone, Chelsea

NPI: 1124497821 LIC: DN21471

CERTIFICATIONS :

• Inhalation Sedation

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010853

Great Expressions Dental Centers

5658 Fishhawk Crossing Blvd

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 83 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Lithia, FL 33547

(813) 490-1982

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 7am-4pm

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010863

Great Expressions Dental Centers

1060 West Busch Blvd, Ste 105

Tampa, FL 33612

(813) 931-4000

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN15989 Jafarnia, Bahareh

NPI: 1407905730 LIC: DN15989

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010867

Great Expressions Dental Centers

2468 W. Brandon Blvd

Brandon, FL 33511

(813) 654-6700

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15989 Jafarnia, Bahareh

NPI: 1407905730 LIC: DN15989

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010869

Great Expressions Dental Centers

13022 Racetrack Rd, Ste 101

Tampa, FL 33626

(813) 814-1868

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN15989 Jafarnia, Bahareh

NPI: 1407905730 LIC: DN15989

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010984

Great Expressions Dental Centers

6552 Gunn Hwy

Tampa, FL 33625

(813) 963-0307

Special Needs: Yes

English, Spanish

M-T 10am-7pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

#010988

Great Expressions Dental Centers

10924 Cross Creek Blvd

Tampa, FL 33647

(813) 982-1777

Special Needs: Yes

English, Russian

M-T 8am-5pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

#010990

Great Expressions Dental Centers

114 N. 12Th St

Tampa, FL 33602

(813) 223-3266

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

#010991

Great Expressions Dental Centers

5101 E. Busch Blvd, Ste #13

Tampa, FL 33617

(813) 988-1167

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN21471 Monteleone, Chelsea

NPI: 1124497821 LIC: DN21471

CERTIFICATIONS :

• Inhalation Sedation

#011011

Great Expressions Dental Centers

4333 W. Bay To Bay Blvd

Tampa, FL 33629

(813) 837-5147

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

#016186

Great Expressions Dental Centers

3806 W. Linebaugh Ave

Tampa, FL 33618

(813) 960-0917

Special Needs: No

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN24084 Cataldo, Dorothy

NPI: 1053849232 LIC: DN24084

CERTIFICATIONS :

# DN21471 Monteleone, Chelsea

NPI: 1124497821 LIC: DN21471

CERTIFICATIONS :

• Inhalation Sedation

# DN18658 Rosen, David

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 84 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010391

Greenberg Dental & Orthodontics

3942 Britton Plz

Tampa, FL 33611

(813) 365-3024

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#010392

Greenberg Dental & Orthodontics

2702 W. Hillsborough Ave

Tampa, FL 33614

(813) 365-3021

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#010579

Greenberg Dental & Orthodontics

234 E. Bearss Ave

Tampa, FL 33613

(813) 337-6353

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 11am - 7pm

W-Th 8am-4pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#013936

Greenberg Dental & Orthodontics

9618 Us Hwy 301 S

Riverview, FL 33578

(813) 867-7062

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#015210

Greenberg Dental & Orthodontics

8851 N. 56Th St

Temple Terrace, FL 33617

(813) 381-5628

Special Needs: Yes

Spanish, Portuguese

M-T 7am-4pm

W-Th 10am-6pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#015441

Greenberg Dental & Orthodontics

12030 Anderson Rd

Tampa, FL 33625

(813) 381-5646

Special Needs: Yes

Spanish

M 7am - 3pm, T 11am - 7pm

W 11am-7pm, Th 7am-3pm,F

7am-2pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#021732

Greenberg Dental & Orthodontics

111 W. Alexander Street

Plant City, FL 33563

(813) 708-6732

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#012052

Greenberg Dental & Orthodontics

10041 W. Hillsborough Ave

Tampa, FL 33615

(813) 235-0957

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

S 7am - 2pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#015277

Greenberg Dental- Brandon

511 W. Brandon Blvd

Brandon, FL 33511

(813) 381-5632

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 85 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Spanish

M 10am - 6pm, T 8am - 4pm

W 10am-6pm, Th 8am-4pm,F

7am-3pm

S 8am - 3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#017044

Growing Smiles Dental Care

18964 N. Dale Mabry Hwy, Ste 101

Lutz, FL 33548

www.growingsmilesdentalcare.com

(813) 591-1568

Special Needs: No

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN20019 Tabares, Yadnay

NPI: 1669602876 LIC: DN20019

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

#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

# DN17860 Ceino, Cruz

NPI: 1801991732 LIC: DN17860

CERTIFICATIONS :

• Inhalation Sedation

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#007987

Happy Kids Pediatric Dentistry

7715 W. Hillsborough Ave

Tampa, FL 33615

(813) 887-5437

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 9am-4pm

W-Th 9am-4pm

# DN17860 Ceino, Cruz

NPI: 1801991732 LIC: DN17860

CERTIFICATIONS :

• Inhalation Sedation

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#010448

Kids Smiles Dental, PLLC

6323 Memorial Hwy Ste 131

Tampa, FL 33615

(813) 889-0780

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN21519 Kwon, Mia

NPI: 1093198160 LIC: DN21519

CERTIFICATIONS :

• Inhalation Sedation

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

CERTIFICATIONS :

• Inhalation Sedation

# DN23297 Patel, Khusbu*

NPI: 1003260910 LIC: DN23297

CERTIFICATIONS :

# DN13285 Sierra, Frank*

NPI: 1215040373 LIC: DN13285

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

#018400

Kids Smiles Dental, PLLC

1773 W. Fletcher Ave

Tampa, FL 33612

(813) 889-0780

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN21519 Kwon, Mia

NPI: 1093198160 LIC: DN21519

CERTIFICATIONS :

• Inhalation Sedation

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

CERTIFICATIONS :

• Inhalation Sedation

# DN23297 Patel, Khusbu

NPI: 1003260910 LIC: DN23297

CERTIFICATIONS :

# DN13285 Sierra, Frank

NPI: 1215040373 LIC: DN13285

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

#018402

Kids Smiles Dental, PLLC

3739 W. Neptune Street

Tampa, FL 33629

kidssmiles.com

(813) 889-0780

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN21519 Kwon, Mia

NPI: 1093198160 LIC: DN21519

CERTIFICATIONS :

• Inhalation Sedation

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

CERTIFICATIONS :

• Inhalation Sedation

# DN23297 Patel, Khusbu

NPI: 1003260910 LIC: DN23297

CERTIFICATIONS :

# DN13285 Sierra, Frank

NPI: 1215040373 LIC: DN13285

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

#011224

KidZone Dentistry

13127 Kings Lake Drive, Ste 101

Gibsonton, FL 33534

(813) 677-3047

Special Needs: Yes

English, Arabic, French, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN18289 Falemban, Mounika

NPI: 1144472713 LIC: DN18289

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#011253

McIlwain Family Dentistry -

HOSPITAL ONLY/REFERRAL

ONLY

4710 N. Habana Ave #203

Tampa, FL 33614

(813) 879-8097

Special Needs: Yes

English, Spanish

M-T 7am-5pm

W-Th 7am-5pm

# DN16024 McIlwain, Michael*

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 86 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1710225362 LIC: DN16024

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

#012063

Michael J. Ruelf, D.D.S.

1308 W. Fletcher Ave

Tampa, FL 33612

(813) 264-6000

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 8am - 5pm

W 8am-5pm, Th 8am-4pm,F 8am-1pm

# DN8253 Ruelf, Michael

NPI: 1083728174 LIC: DN8253

CERTIFICATIONS :

• Board Certification

• 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

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN21749 Black, Harrison

NPI: 1750780052 LIC: DN21749

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18568 Gyles, Richard

NPI: 1942211180 LIC: DN18568

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19520 Lasanta, Denisse

NPI: 1801174131 LIC: DN19520

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# 19991FL Newcity, Amanda

NPI: 1457615668 LIC: 19991FL

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#012948

Pediatric Dental Center

1540 S Dale Mabry Hwy

Tampa, FL 33629

(813) 254-8457

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN6377 Gonzalez, William

NPI: 1003930579 LIC: DN6377

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

# DN21662 Adibi, Farnaz*

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN21749 Black, Harrison*

NPI: 1750780052 LIC: DN21749

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18568 Gyles, Richard*

NPI: 1942211180 LIC: DN18568

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22366 Iyer, Priyanka*

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19520 Lasanta, Denisse*

NPI: 1801174131 LIC: DN19520

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# 19991FL Newcity, Amanda*

NPI: 1457615668 LIC: 19991FL

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#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

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN21749 Black, Harrison

NPI: 1750780052 LIC: DN21749

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18568 Gyles, Richard

NPI: 1942211180 LIC: DN18568

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19520 Lasanta, Denisse

NPI: 1801174131 LIC: DN19520

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# 19991FL Newcity, Amanda

NPI: 1457615668 LIC: 19991FL

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#013982

Smile Design

5306 Van Dyke Rd

Lutz, FL 33558

(813) 960-3300

Special Needs: Yes

English

M 8am - 4pm, T 9am - 6pm

W-Th 8am-5pm

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#011881

Smile Design Citrus Park

13246 N Dale Mabry Hwy

Tampa, FL 33618

(813) 926-6776

Special Needs: Yes

English, Arabic, Spanish

M-T 8am-5pm

W 9am-6pm, Th 8am-5pm,F 7am-3pm

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#013981

Smile Design Fletcher

4446 E Fletcher Ave Ste F

Tampa, FL 33613

(813) 910-2345

Special Needs: Yes

English

M 10am - 7pm, 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 87 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W 8am-5pm, Th 10am-7pm,F

8am-4pm

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#011884

Smile Design Lithia

3442 Lithia Pinecrest Rd

Valrico, FL 33596

(813) 662-1111

Special Needs: Yes

English, Spanish

M 8am - 5pm, T 10am - 7pm

W-F 8am-5pm

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#011886

Smile Design Riverview

11693 Boyette Rd

Riverview, FL 33569

(813) 672-2066

Special Needs: Yes

English, Spanish

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#011888

Smile Design Tampa Palms

16021 Tampa Palms Blvd W

Tampa, FL 33647

(813) 960-3300

Special Needs: Yes

English

M 8am - 4pm, T 8am - 5pm

W-Th 8am-5pm

# DN21646 Theogene, Dorothy

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#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

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN21749 Black, Harrison

NPI: 1750780052 LIC: DN21749

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18568 Gyles, Richard

NPI: 1942211180 LIC: DN18568

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19520 Lasanta, Denisse

NPI: 1801174131 LIC: DN19520

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# 19991FL Newcity, Amanda

NPI: 1457615668 LIC: 19991FL

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#FQHC10203

Tampa Family Health Centers,

Inc.

3901 S. West Shore Blvd

Tampa, FL 33611

(813) 397-5300

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 88 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

#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

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN21749 Black, Harrison

NPI: 1750780052 LIC: DN21749

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18568 Gyles, Richard

NPI: 1942211180 LIC: DN18568

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19520 Lasanta, Denisse

NPI: 1801174131 LIC: DN19520

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# 19991FL Newcity, Amanda

NPI: 1457615668 LIC: 19991FL

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010449

Young Smiles Pediatric Dentistry

and Spa, PA

13131 Kings Lake Drive, Ste #104

Gibsonton, FL 33534

youngsmilesdental.net

(813) 829-9075

Special Needs: Yes

English, Spanish

M 9am - 6pm, T 8am - 5pm

W 9am-6pm, Th 8am-5pm,F

8am-12pm

# DN15193 Young, Kera*

NPI: 1467484097 LIC: DN15193

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

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 :

#010391

Greenberg Dental & Orthodontics

3942 Britton Plz

Tampa, FL 33611

(813) 365-3024

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#010392

Greenberg Dental & Orthodontics

2702 W. Hillsborough Ave

Tampa, FL 33614

(813) 365-3021

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#010579

Greenberg Dental & Orthodontics

234 E. Bearss Ave

Tampa, FL 33613

(813) 337-6353

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 11am - 7pm

W-Th 8am-4pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#013936

Greenberg Dental & Orthodontics

9618 Us Hwy 301 S

Riverview, FL 33578

(813) 867-7062

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#015210

Greenberg Dental & Orthodontics

8851 N. 56Th St

Temple Terrace, FL 33617

(813) 381-5628

Special Needs: Yes

Spanish, Portuguese

M-T 7am-4pm

W-Th 10am-6pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#015441

Greenberg Dental & Orthodontics

12030 Anderson Rd

Tampa, FL 33625

(813) 381-5646

Special Needs: Yes

Spanish

M 7am - 3pm, T 11am - 7pm

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 89 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W 11am-7pm, Th 7am-3pm,F

7am-2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#012052

Greenberg Dental & Orthodontics

10041 W. Hillsborough Ave

Tampa, FL 33615

(813) 235-0957

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

S 7am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#015277

Greenberg Dental- Brandon

511 W. Brandon Blvd

Brandon, FL 33511

(813) 381-5632

Special Needs: No

Spanish

M 10am - 6pm, T 8am - 4pm

W 10am-6pm, Th 8am-4pm,F

7am-3pm

S 8am - 3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

PROSTHODONTICS

#010847

Great Expressions Dental Centers

15148 N. Dale Mabry Hwy

Tampa, FL 33618

(813) 960-0106

Special Needs: Yes

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

# DN22473 Dinse, William

NPI: 1487645164 LIC: DN22473

CERTIFICATIONS :

#010853

Great Expressions Dental Centers

5658 Fishhawk Crossing Blvd

Lithia, FL 33547

(813) 490-1982

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 7am-4pm

# DN22473 Dinse, William

NPI: 1487645164 LIC: DN22473

CERTIFICATIONS :

#010867

Great Expressions Dental Centers

2468 W. Brandon Blvd

Brandon, FL 33511

(813) 654-6700

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN22473 Dinse, William

NPI: 1487645164 LIC: DN22473

CERTIFICATIONS :

#011011

Great Expressions Dental Centers

4333 W. Bay To Bay Blvd

Tampa, FL 33629

(813) 837-5147

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-5pm

# DN22473 Dinse, William

NPI: 1487645164 LIC: DN22473

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

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 90 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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 :

ENDODONTICS

#013012

Glen T. Casto DDS, MDS, PA

621 Sebastian Blvd, Ste B

Sebastian, FL 32958

www.drcasto.com

(772) 388-6400

Special Needs: Yes

English

M-T 9am-5pm

W-F 9am-5pm

# DN16640 Casto, Glen

NPI: 1184705832 LIC: DN16640

CERTIFICATIONS :

ORTHODONTIST

#022655

Kevin S. Vakani DDS PLLC

2050 40Th Ave, Ste 4

Vero Beach, FL 32960

(772) 400-1304

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21191 Vakani, Kevin

NPI: 1548618523 LIC: DN21191

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

LAFAYETTE COUNTY

DENTIST

#CHC9903

DOH - Lafayette 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 91 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

140 Sw Virginia Circle

Mayo, FL 32066

(386) 294-1321

Special Needs: Yes

English

M 8am - 5pm,

# DN12159 Hill, Elizabeth

NPI: 1760490734 LIC: DN12159

CERTIFICATIONS :

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 :

#011785

Central Florida Dental Group

1804 Oakley Seaver Dr. Ste G

Clermont, FL 34711

(407) 654-4024

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN16410 Ortiz, Carlos

NPI: 1922147826 LIC: DN16410

CERTIFICATIONS :

# DN16411 Ortiz, Iris

NPI: 1245641950 LIC: DN16411

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

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

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 92 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#CHC10100

Florida Department of Health -

Lake County

3261 Us Hwy 441/27, Ste F1

Fruitland Park, FL 34731

(352) 360-6602

Special Needs: N/A

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN11385 Traul Jr., Robert

NPI: 1982734257 LIC: DN11385

CERTIFICATIONS :

#015128

Greenberg Dental - Clermont

680 E. State Rd 50

Clermont, FL 34711

(352) 241-4500

Special Needs: Yes

M 7am - 5pm, T 7am - 7pm

W 7am-7pm, Th 7am-5pm,F 8am-4pm

S 8am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

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 93 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015135

Greenberg Dental - Leesburg

949 N. 14Th St

Leesburg, FL 34748

(352) 460-0164

Special Needs: Yes

English, Spanish, French

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 2pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

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 94 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#011629

Greenberg Dental & Orthodontics

PA - Eustis

15455 Us Hwy 441

Eustis, FL 32726

(352) 399-0911

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

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 95 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

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 :

#015272

Lady Lake Dental Care, LLC

13915 N. Us Hwy 441

Lady Lake, FL 32159

(352) 753-6365

Special Needs: Yes

English

M-T 9am-5pm

W-F 9am-5pm

# DN13227 Johary, Carlos

NPI: 1336338755 LIC: DN13227

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

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 96 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# 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 :

ENDODONTICS

#015128

Greenberg Dental - Clermont

680 E. State Rd 50

Clermont, FL 34711

(352) 241-4500

Special Needs: Yes

M 7am - 5pm, T 7am - 7pm

W 7am-7pm, Th 7am-5pm,F 8am-4pm

S 8am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015135

Greenberg Dental - Leesburg

949 N. 14Th St

Leesburg, FL 34748

(352) 460-0164

Special Needs: Yes

English, Spanish, French

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 2pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#011629

Greenberg Dental & Orthodontics

PA - Eustis

15455 Us Hwy 441

Eustis, FL 32726

(352) 399-0911

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

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 97 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

ORAL SURGEON

#015128

Greenberg Dental - Clermont

680 E. State Rd 50

Clermont, FL 34711

(352) 241-4500

Special Needs: Yes

M 7am - 5pm, T 7am - 7pm

W 7am-7pm, Th 7am-5pm,F 8am-4pm

S 8am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015135

Greenberg Dental - Leesburg

949 N. 14Th St

Leesburg, FL 34748

(352) 460-0164

Special Needs: Yes

English, Spanish, French

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 2pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#011629

Greenberg Dental & Orthodontics

PA - Eustis

15455 Us Hwy 441

Eustis, FL 32726

(352) 399-0911

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#020753

Oral Facial Surgical Arts PA

3180 Citrus Tower Blvd

Clermont, FL 34711

(352) 243-5599

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN16913 Achong, Ronald*

NPI: 1568485282 LIC: DN16913

CERTIFICATIONS :

# DN18401 Latham, Christopher*

NPI: 1831353747 LIC: DN18401

CERTIFICATIONS :

ORTHODONTIST

#015128

Greenberg Dental - Clermont

680 E. State Rd 50

Clermont, FL 34711

(352) 241-4500

Special Needs: Yes

M 7am - 5pm, T 7am - 7pm

W 7am-7pm, Th 7am-5pm,F 8am-4pm

S 8am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015135

Greenberg Dental - Leesburg

949 N. 14Th St

Leesburg, FL 34748

(352) 460-0164

Special Needs: Yes

English, Spanish, French

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 2pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

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 98 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#011629

Greenberg Dental & Orthodontics

PA - Eustis

15455 Us Hwy 441

Eustis, FL 32726

(352) 399-0911

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#020863

Clermont Kids Dentistry

1655 E. Highway 50 Ste# 101

Clermont, FL 34711

www.clermontkidsdentistry.com

(407) 205-1114

Special Needs: Yes

English, Spanish, Persian

M-T 8am-5pm

W-F 8am-5pm

S 9am - 3pm

# DN23577 Tartibi, Faraz

NPI: 1639520794 LIC: DN23577

CERTIFICATIONS :

• Inhalation Sedation

#015128

Greenberg Dental - Clermont

680 E. State Rd 50

Clermont, FL 34711

(352) 241-4500

Special Needs: Yes

M 7am - 5pm, T 7am - 7pm

W 7am-7pm, Th 7am-5pm,F 8am-4pm

S 8am - 3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015135

Greenberg Dental - Leesburg

949 N. 14Th St

Leesburg, FL 34748

(352) 460-0164

Special Needs: Yes

English, Spanish, French

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 2pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#011629

Greenberg Dental & Orthodontics

PA - Eustis

15455 Us Hwy 441

Eustis, FL 32726

(352) 399-0911

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious 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 99 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#020458

Main Street Childrens Dentistry

& Ortho Of Clermont PLLC

2410 E. Highway 50, Bldg D, Ste A

Clermont, FL 34711

(352) 432-0090

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN20826 Tejada, Rodolfo

NPI: 1427345057 LIC: DN20826

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

PERIODONTICS

#015128

Greenberg Dental - Clermont

680 E. State Rd 50

Clermont, FL 34711

(352) 241-4500

Special Needs: Yes

M 7am - 5pm, T 7am - 7pm

W 7am-7pm, Th 7am-5pm,F 8am-4pm

S 8am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015135

Greenberg Dental - Leesburg

949 N. 14Th St

Leesburg, FL 34748

(352) 460-0164

Special Needs: Yes

English, Spanish, French

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 2pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#011629

Greenberg Dental & Orthodontics

PA - Eustis

15455 Us Hwy 441

Eustis, FL 32726

(352) 399-0911

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

PROSTHODONTICS

#015128

Greenberg Dental - Clermont

680 E. State Rd 50

Clermont, FL 34711

(352) 241-4500

Special Needs: Yes

M 7am - 5pm, T 7am - 7pm

W 7am-7pm, Th 7am-5pm,F 8am-4pm

S 8am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015135

Greenberg Dental - Leesburg

949 N. 14Th St

Leesburg, FL 34748

(352) 460-0164

Special Needs: Yes

English, Spanish, French

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 2pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#011629

Greenberg Dental & Orthodontics

PA - Eustis

15455 Us Hwy 441

Eustis, FL 32726

(352) 399-0911

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

LEE COUNTY

DENTIST

#010969

Barkley Circle Dental Center

45 Barkley Circle

Fort Myers, FL 33907

(239) 939-0423

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN20624 Fall, Emily*

NPI: 1518370360 LIC: DN20624

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#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

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 100 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#FQHC010638

Family Health Centers of

Southwest Florida, Inc.

11921 Saradrienne Lane, Ste 8

Bonita Springs, FL 34135

(239) 344-2322

Special Needs: Yes

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

#FQHC010639

Family Health Centers of

Southwest Florida, Inc.

3600 Broadway Ave, Ste A

Fort Myers, FL 33901

(239) 344-2335

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

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 101 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

#FQHC010640

Family Health Centers of

Southwest Florida, Inc.

2232 Grand Ave

Fort Myers, FL 33901

www.fhcswf.org

(239) 344-2344

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

#FQHC010643

Family Health Centers of

Southwest Florida, Inc.

3415 Lee Blvd

Lehigh Acres, FL 33971

(239) 344-2385

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

#FQHC010644

Family Health Centers of

Southwest Florida, Inc.

8359 Stringfellow Rd

Saint James City, FL 33956

(239) 344-2354

Special Needs: Yes

English, Spanish

T 8am - 5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

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 102 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

#FQHC011185

Family Health Centers of

Southwest Florida, Inc.

19701 S Tamiami Trl

Fort Myers, FL 33908

(239) 314-1630

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

#FQHC012768

Family Health Centers of

Southwest Florida, Inc.

316 Del Prado Blvd

Cape Coral, FL 33990

www.fhcswf.org

(239) 226-2630

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16934 Alvarado, Carlos

NPI: 1578549473 LIC: DN16934

CERTIFICATIONS :

# DN23350 Aportela, Arleen

NPI: 1538659883 LIC: DN23350

CERTIFICATIONS :

# DN18769 Blanco, Maria

NPI: 1134369762 LIC: DN18769

CERTIFICATIONS :

# DN21345 De La Cruz, Javier

NPI: 1700267911 LIC: DN21345

CERTIFICATIONS :

• Inhalation Sedation

# DN23550 Goldstein, Brett

NPI: 1720572027 LIC: DN23550

CERTIFICATIONS :

# DN23019 Jimenez-Mauri, Yvania

NPI: 1568821700 LIC: DN23019

CERTIFICATIONS :

# DN6062 Mazzeo Jr., Frank

NPI: 1962597047 LIC: DN6062

CERTIFICATIONS :

# DN17266 Natali, Anabel

NPI: 1386606127 LIC: DN17266

CERTIFICATIONS :

• Inhalation Sedation

# DN20829 Pardo, Gustavo

NPI: 1306254156 LIC: DN20829

CERTIFICATIONS :

# DN24096 Rodriguez, Eduardo

NPI: 1205986445 LIC: DN24096

CERTIFICATIONS :

# DN21544 Rodriguez-Riera, Luis

NPI: 1487028973 LIC: DN21544

CERTIFICATIONS :

# DN24022 Salazar, Nataly

NPI: 1063919975 LIC: DN24022

CERTIFICATIONS :

# DN23346 Sampaio, Rafaella

NPI: 1447742184 LIC: DN23346

CERTIFICATIONS :

# DN23372 Seebunpang, Sirirat

NPI: 1043702756 LIC: DN23372

CERTIFICATIONS :

# DN20526 Solomon, Dorian

NPI: 1740606748 LIC: DN20526

CERTIFICATIONS :

# DN23606 Williams, Matthew

NPI: 1205321403 LIC: DN23606

CERTIFICATIONS :

#010855

Great Expressions Dental Centers

10580 Colonial Blvd, Ste 103

Ft Myers, FL 33913

(239) 210-2926

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20442 Pocialik, Gordon

NPI: 1184990848 LIC: DN20442

CERTIFICATIONS :

• Inhalation Sedation

#010983

Great Expressions Dental Centers

1616 West Cape Coral Parkway, Ste

115

Cape Coral, FL 33914

(239) 549-7771

Special Needs: Yes

English

M-T 8am-5pm

W-F 7am-3pm

# DN21897 Delgado, Aaron

NPI: 1518482868 LIC: DN21897

CERTIFICATIONS :

# DN19883 Mier Parsons, Andrea

NPI: 1306104351 LIC: DN19883

CERTIFICATIONS :

#010985

Great Expressions Dental Centers

9250 College Parkway, Ste 1

Fort Myers, FL 33919

(239) 437-4014

Special Needs: Yes

M-T 8am-5pm

W-F 8am-5pm

# DN23256 Cubero, Lilyann

NPI: 1942741863 LIC: DN23256

CERTIFICATIONS :

# DN10744 Fidler, Russell

NPI: 1801973466 LIC: DN10744

CERTIFICATIONS :

# DN22119 Plaza, Emily

NPI: 1669830212 LIC: DN22119

CERTIFICATIONS :

#010989

Great Expressions Dental Centers

1127 Del Prado Blvd S, Ste D & E

Cape Coral, FL 33990

(239) 573-2323

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23487 Eckardt, Jordan

NPI: 1023501293 LIC: DN23487

CERTIFICATIONS :

# DN10744 Fidler, Russell

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 103 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1801973466 LIC: DN10744

CERTIFICATIONS :

#011230

Great Expressions Dental Centers

25195 Chamber Of Commerce Drive

Bonita Springs, FL 34135

(239) 947-7481

Special Needs: Yes

English

M-T 8am-5pm

W 8am-5pm,

# DN23256 Cubero, Lilyann

NPI: 1942741863 LIC: DN23256

CERTIFICATIONS :

# DN22119 Plaza, Emily

NPI: 1669830212 LIC: DN22119

CERTIFICATIONS :

# DN20442 Pocialik, Gordon

NPI: 1184990848 LIC: DN20442

CERTIFICATIONS :

• Inhalation Sedation

#012555

Great Expressions Dental Centers

5100 S Cleveland Ave, Units 315 &

316

Fort Myers, FL 33907

(239) 768-2588

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN23256 Cubero, Lilyann

NPI: 1942741863 LIC: DN23256

CERTIFICATIONS :

# DN21897 Delgado, Aaron

NPI: 1518482868 LIC: DN21897

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 :

• 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

#010880

Pediatric Dentistry of Ft. Myers

8016 Summerlin Lakes Drive

Fort Myers, FL 33907

drverwest.com

(239) 482-2722

Special Needs: Yes

English, Arabic, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN24064 Hawasli, Deena

NPI: 1154988491 LIC: DN24064

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 :

#007912

Ricardo Perales, DMD PA

25 Homestead Rd. N, Ste 39A

Lehigh Acres, FL 33936

grandental.center

(239) 368-4997

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-Th 8am-5pm

# DN15473 Perales, Ricardo

NPI: 1811173560 LIC: DN15473

CERTIFICATIONS :

ENDODONTICS

#016144

Dental Specialty Center of Cape

Coral

821 Cape Coral Pkwy W, Unit 3-5

Cape Coral, FL 33914

(239) 540-4085

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17756 Galsterer, Mark

NPI: 1780733469 LIC: DN17756

CERTIFICATIONS :

• Inhalation Sedation

#011309

Dental Specialty Center of Ft.

Myers, PA

7011 Cypress Terrace, Ste 101

Ft Myers, FL 33907

(239) 433-3075

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17756 Galsterer, Mark

NPI: 1780733469 LIC: DN17756

CERTIFICATIONS :

• Inhalation Sedation

#014683

Towncare Dental of Bonita

Springs, PA

16565 Vanderbilt Drive

Bonita Springs, FL 34134

(239) 498-6780

Special Needs: Yes

English, Spanish

T 8am - 5pm

# DN17756 Galsterer, Mark

NPI: 1780733469 LIC: DN17756

CERTIFICATIONS :

• Inhalation Sedation

ORAL SURGEON

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 104 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#016144

Dental Specialty Center of Cape

Coral

821 Cape Coral Pkwy W, Unit 3-5

Cape Coral, FL 33914

(239) 540-4085

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21883 Hall, Kevin

NPI: 1447512421 LIC: DN21883

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#011309

Dental Specialty Center of Ft.

Myers, PA

7011 Cypress Terrace, Ste 101

Ft Myers, FL 33907

(239) 433-3075

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21883 Hall, Kevin

NPI: 1447512421 LIC: DN21883

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#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

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

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

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

#012327

Main Street Children's Dentistry

and Orthodontics of Ft. Mye

13195 Metro Pkwy

Ft Myers, FL 33966

(239) 768-2485

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), French

M-T 8am-5pm

W-F 8am-5pm

# DN17966 Freedman, Matthew*

NPI: 1386843449 LIC: DN17966

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#010969

Barkley Circle Dental Center

45 Barkley Circle

Fort Myers, FL 33907

(239) 939-0423

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN16262 Ahmadi, Anissa*

NPI: 1912045147 LIC: DN16262

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN16995 McDowell, Hope*

NPI: 1164560397 LIC: DN16995

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#012457

Main Street Children's Dentistry

and Orthodontics of Cape Co

1715 Cape Coral Pkwy West, Unit 13

Cape Coral, FL 33914

(239) 542-3185

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17804 Gedeon, Rose

NPI: 1063547545 LIC: DN17804

CERTIFICATIONS :

• Inhalation Sedation

# DN19083 Hester, Jordan

NPI: 1972814820 LIC: DN19083

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#012327

Main Street Children's Dentistry

and Orthodontics of Ft. Mye

13195 Metro Pkwy

Ft Myers, FL 33966

(239) 768-2485

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), French

M-T 8am-5pm

W-F 8am-5pm

# DN17804 Gedeon, Rose

NPI: 1063547545 LIC: DN17804

CERTIFICATIONS :

• Inhalation Sedation

# DN20379 Josephs, Elias

NPI: 1942511803 LIC: DN20379

CERTIFICATIONS :

• Inhalation Sedation

#021257

Pediatric Dentistry of Bonita

9510 Bonita Beach Road Se, Ste 101

Bonita Springs, FL 34135

(239) 333-2990

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN15921 Argumosa, Miguel*

NPI: 1184653347 LIC: DN15921

CERTIFICATIONS :

• Board Certification

# DN18365 Ascunce, Leanet*

NPI: 1710130661 LIC: DN18365

CERTIFICATIONS :

• Inhalation Sedation

# DN20011 Eastham, Nicole*

NPI: 1699039867 LIC: DN20011

CERTIFICATIONS :

# DN17031 Taylor, Erin*

NPI: 1417018953 LIC: DN17031

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

#021673

Pediatric Dentistry of Cape Coral

1508 Se 12Th Terrace

Cape Coral, FL 33990

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 105 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(239) 322-5222

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN15921 Argumosa, Miguel*

NPI: 1184653347 LIC: DN15921

CERTIFICATIONS :

• Board Certification

# DN18365 Ascunce, Leanet*

NPI: 1710130661 LIC: DN18365

CERTIFICATIONS :

• Inhalation Sedation

# DN20011 Eastham, Nicole*

NPI: 1699039867 LIC: DN20011

CERTIFICATIONS :

# DN17031 Taylor, Erin*

NPI: 1417018953 LIC: DN17031

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

#010880

Pediatric Dentistry of Ft. Myers

8016 Summerlin Lakes Drive

Fort Myers, FL 33907

drverwest.com

(239) 482-2722

Special Needs: Yes

English, Arabic, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18365 Ascunce, Leanet

NPI: 1710130661 LIC: DN18365

CERTIFICATIONS :

• Inhalation Sedation

# DN23996 Liu, Tong

NPI: 1043665227 LIC: DN23996

CERTIFICATIONS :

# DN12089 Verwest, Tim

NPI: 1013981620 LIC: DN12089

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#014430

Preventive Dentistry For Children,

260 Beth Stacey Blvd # 240

Lehigh Acres, FL 33936

kidsdentistflorifa.com

(239) 491-6977

Special Needs: Yes

English, Spanish, French

M-T 9am-6pm

W-F 9am-6pm

S 9am - 6pm

# DN17035 Vedrenne-Rangel, Denise

NPI: 1942401773 LIC: DN17035

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

PERIODONTICS

#016144

Dental Specialty Center of Cape

Coral

821 Cape Coral Pkwy W, Unit 3-5

Cape Coral, FL 33914

(239) 540-4085

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19411 Broderick, Anne

NPI: 1831419456 LIC: DN19411

CERTIFICATIONS :

• Inhalation Sedation

#011309

Dental Specialty Center of Ft.

Myers, PA

7011 Cypress Terrace, Ste 101

Ft Myers, FL 33907

(239) 433-3075

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19411 Broderick, Anne

NPI: 1831419456 LIC: DN19411

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN22732 Chhabra, Mudrika

NPI: 1093101263 LIC: DN22732

CERTIFICATIONS :

• General Anesthesia

# DN9380 Manocha, Ashok

NPI: 1467669606 LIC: DN9380

CERTIFICATIONS :

# DN7339 Tolley, Leonard

NPI: 1902822497 LIC: DN7339

CERTIFICATIONS :

#CHC10236

DOH - Leon County Health

Department

912 Railroad Ave

Tallahassee, FL 32310

(850) 404-6450

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21218 Baptiste, Ashley

NPI: 1548642887 LIC: DN21218

CERTIFICATIONS :

# HAD52 Bencic, Robert

NPI: 1801071774 LIC: HAD52

CERTIFICATIONS :

# DN10711 Bidwell, John

NPI: 1174553689 LIC: DN10711

CERTIFICATIONS :

• Inhalation Sedation

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN16771 Liu, Jiguo

NPI: 1629036298 LIC: DN16771

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

# DN21150 Rugmini Pillai, Prathibha

NPI: 1639466006 LIC: DN21150

CERTIFICATIONS :

• Inhalation Sedation

# DN11385 Traul Jr., Robert

NPI: 1982734257 LIC: DN11385

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 106 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21933 Vu, Clara*

NPI: 1235589482 LIC: DN21933

CERTIFICATIONS :

• Inhalation Sedation

#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

#016888

Tiny Teeth of Tally, PLLC

1614 W Plaza Dr

Tallahassee, FL 32308

(850) 792-9100

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN22443 Gonzalez, Astrid*

NPI: 1235473018 LIC: DN22443

CERTIFICATIONS :

• Inhalation Sedation

ORTHODONTIST

#021448

SmileWorks PLLC

1771 Capital Cir. Ne

Tallahassee, FL 32308

(850) 765-3748

Special Needs: Yes

English

M-T 8am-4pm

# DN18574 Long, Brion

NPI: 1881846798 LIC: DN18574

CERTIFICATIONS :

LEVY COUNTY

DENTIST

#CHC015358

DOH - Levy County Health

Department

66 W. Main St

Bronson, FL 32621

(352) 486-5300

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN15416 Elam, Christine

NPI: 1922136092 LIC: DN15416

CERTIFICATIONS :

# DN14796 Turner, David

NPI: 1679894257 LIC: DN14796

CERTIFICATIONS :

#FQHC015483

Palms Dentistry

630 N. Main St

Williston, FL 32696

www.palmsmg.org

(352) 528-2447

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN9869 Jones, Stanley

NPI: 1528162047 LIC: DN9869

CERTIFICATIONS :

# DN22911 Koubek, Catherine

NPI: 1730619594 LIC: DN22911

CERTIFICATIONS :

• Inhalation Sedation

# DN24208 Lima, Pamela

NPI: 1982264438 LIC: DN24208

CERTIFICATIONS :

# DN20927 Rooney, Matthew

NPI: 1598165532 LIC: DN20927

CERTIFICATIONS :

• Inhalation Sedation

LIBERTY COUNTY

DENTIST

#CHC10279

DOH - Liberty County Health

Department-School Based ONLY

10971 Nw Spring St

Bristol, FL 32321

(850) 643-2415

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19827 Barth, Nicholas*

NPI: 1396090320 LIC: DN19827

CERTIFICATIONS :

• Inhalation Sedation

# DN18661 Whitford, Drew*

NPI: 1851527303 LIC: DN18661

CERTIFICATIONS :

• Inhalation Sedation

#014656

Healthy Smiles, Happy Students -

School Based Only

17316 Ne Sr 65

Hosford, FL 32334

(850) 379-5800

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19827 Barth, Nicholas

NPI: 1396090320 LIC: DN19827

CERTIFICATIONS :

• Inhalation Sedation

# DN22006 Gregg, Nicholas

NPI: 1164874046 LIC: DN22006

CERTIFICATIONS :

MADISON COUNTY

DENTIST

#010876

Madison Dental Associates

189 Sw Captain Brown Road

Madison, FL 32340

(850) 973-6621

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 107 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN18144 Allen, Matthew

NPI: 1871744896 LIC: DN18144

CERTIFICATIONS :

• Inhalation Sedation

# DN15232 Rogers, Clint

NPI: 1548489818 LIC: DN15232

CERTIFICATIONS :

• Inhalation Sedation

MANATEE COUNTY

DENTIST

#010860

Great Expressions Dental Centers

11215 E State Road 70

Lakewood Ranch, FL 34202

(941) 757-0490

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN22938 Sanchez, Diego

NPI: 1902329816 LIC: DN22938

CERTIFICATIONS :

# DN22138 Sandesara, Pooja

NPI: 1396108296 LIC: DN22138

CERTIFICATIONS :

• Inhalation Sedation

# DN13640 Schaffner, Daniel

NPI: 1548339815 LIC: DN13640

CERTIFICATIONS :

• Inhalation Sedation

# DN22695 Toribio Fabelo, Leydy

NPI: 1033639554 LIC: DN22695

CERTIFICATIONS :

• Inhalation Sedation

#012473

Greenberg Dental & Orthodontics

5580 Cortez Rd W

Bradenton, FL 34210

(941) 914-9181

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

S 7am - 2pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#012755

Greenberg Dental & Orthodontics

579 10Th St E

Palmetto, FL 34221

(941) 315-9914

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 108 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Special Needs: Yes

English, Korean, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#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

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

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 109 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#020826

Greenberg Dental & Orthodontics

3122 53Rd Ave East

Bradenton, FL 34203

(941) 357-2968

Special Needs: No

English, Spanish, Portuguese

M 10am - 6pm, T 8am - 4pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN22704 Foreman, Kathleen

NPI: 1407377724 LIC: DN22704

CERTIFICATIONS :

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN22428 Salehi, Shiva

NPI: 1346696549 LIC: DN22428

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#014960

Greenberg Dental &

Orthodontics-Bradenton

8754 E. State Road 70 Ste 8752

Bradenton, FL 34202

(941) 702-2229

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-Th 8am-4pm

S 7am - 2pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

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 110 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#FQHC015357

Lawton Chiles Dental

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

# 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

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 111 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

ENDODONTICS

#012473

Greenberg Dental & Orthodontics

5580 Cortez Rd W

Bradenton, FL 34210

(941) 914-9181

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

S 7am - 2pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#012755

Greenberg Dental & Orthodontics

579 10Th St E

Palmetto, FL 34221

(941) 315-9914

Special Needs: Yes

English, Korean, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#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

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#020826

Greenberg Dental & Orthodontics

3122 53Rd Ave East

Bradenton, FL 34203

(941) 357-2968

Special Needs: No

English, Spanish, Portuguese

M 10am - 6pm, T 8am - 4pm

W 8am-4pm, Th 10am-6pm,F

7am-3pm

S 7am - 2pm

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

#014960

Greenberg Dental &

Orthodontics-Bradenton

8754 E. State Road 70 Ste 8752

Bradenton, FL 34202

(941) 702-2229

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-Th 8am-4pm

S 7am - 2pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

ORAL SURGEON

#012473

Greenberg Dental & Orthodontics

5580 Cortez Rd W

Bradenton, FL 34210

(941) 914-9181

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

S 7am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#012755

Greenberg Dental & Orthodontics

579 10Th St E

Palmetto, FL 34221

(941) 315-9914

Special Needs: Yes

English, Korean, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#014072

Greenberg Dental & Orthodontics

8446 Lockwood Ridge Rd

Sarasota, FL 34243

(941) 312-2024

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 112 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#014960

Greenberg Dental &

Orthodontics-Bradenton

8754 E. State Road 70 Ste 8752

Bradenton, FL 34202

(941) 702-2229

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-Th 8am-4pm

S 7am - 2pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#014747

Blue Wave Ortho Partners, PLLC

6020 State Road 70 Ste 101

Bradenton, FL 34203

(941) 757-8948

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21728 Cetta, Christopher

NPI: 1689893240 LIC: DN21728

CERTIFICATIONS :

#012473

Greenberg Dental & Orthodontics

5580 Cortez Rd W

Bradenton, FL 34210

(941) 914-9181

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

S 7am - 2pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#012755

Greenberg Dental & Orthodontics

579 10Th St E

Palmetto, FL 34221

(941) 315-9914

Special Needs: Yes

English, Korean, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#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

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#014960

Greenberg Dental &

Orthodontics-Bradenton

8754 E. State Road 70 Ste 8752

Bradenton, FL 34202

(941) 702-2229

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-Th 8am-4pm

S 7am - 2pm

# DN20464 Guloy, Robertzon

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#014774

Mann Orthodontics, PA

4915 96Th St. East

Palmetto, FL 34221

www.mannmadesmiles.com

(941) 359-9711

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN20141 Mann, Nicholas

NPI: 1508205139 LIC: DN20141

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#014747

Blue Wave Ortho Partners, PLLC

6020 State Road 70 Ste 101

Bradenton, FL 34203

(941) 757-8948

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

CERTIFICATIONS :

• Inhalation Sedation

#020333

DAB Dental Center, PLLC

205 6Th Ave, E. Ste A

Bradenton, FL 34208

(941) 746-0443

Special Needs: No

English

W 8am-12pm,

# DN5961 Bowles, David

NPI: 1649342635 LIC: DN5961

CERTIFICATIONS :

• General Anesthesia

#010860

Great Expressions Dental Centers

11215 E State Road 70

Lakewood Ranch, FL 34202

(941) 757-0490

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN21333 Tate, Ashley

NPI: 1457719627 LIC: DN21333

CERTIFICATIONS :

#012473

Greenberg Dental & Orthodontics

5580 Cortez Rd W

Bradenton, FL 34210

(941) 914-9181

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

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 113 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

S 7am - 2pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#012755

Greenberg Dental & Orthodontics

579 10Th St E

Palmetto, FL 34221

(941) 315-9914

Special Needs: Yes

English, Korean, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#014960

Greenberg Dental &

Orthodontics-Bradenton

8754 E. State Road 70 Ste 8752

Bradenton, FL 34202

(941) 702-2229

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-Th 8am-4pm

S 7am - 2pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

#022493

Kids Smiles Dental, PLLC

6020 State Road 70, Ste 101

Bradenton, FL 34203

(941) 751-1533

Special Needs: Yes

English, Spanish

# DN21519 Kwon, Mia

NPI: 1093198160 LIC: DN21519

CERTIFICATIONS :

• Inhalation Sedation

# DN23297 Patel, Khusbu

NPI: 1003260910 LIC: DN23297

CERTIFICATIONS :

# DN13285 Sierra, Frank

NPI: 1215040373 LIC: DN13285

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

#FQHC015357

Lawton Chiles Dental

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

# DN19841 Grant, Debbie

NPI: 1639434749 LIC: DN19841

CERTIFICATIONS :

#020733

Main Street Children's Dentistry

& Orthodontics of Lakewood

11649 Sr 70 East, Ste 109

Lakewood Ranch, FL 34202

(941) 209-1213

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN18365 Ascunce, Leanet

NPI: 1710130661 LIC: DN18365

CERTIFICATIONS :

• Inhalation Sedation

# DN23280 Polanco, Alejandra

NPI: 1487181541 LIC: DN23280

CERTIFICATIONS :

• Inhalation Sedation

#M013843

Manatee County Rural Health

Serv, - Health Express (Mobile)

12271 Us Hwy 301 N

Parrish, FL 34219

(941) 713-2081

Special Needs: Yes

English

# DN19841 Grant, Debbie

NPI: 1639434749 LIC: DN19841

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

# DN19841 Grant, Debbie

NPI: 1639434749 LIC: DN19841

CERTIFICATIONS :

PERIODONTICS

#012473

Greenberg Dental & Orthodontics

5580 Cortez Rd W

Bradenton, FL 34210

(941) 914-9181

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

S 7am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#012755

Greenberg Dental & Orthodontics

579 10Th St E

Palmetto, FL 34221

(941) 315-9914

Special Needs: Yes

English, Korean, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#014072

Greenberg Dental & Orthodontics

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 114 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

8446 Lockwood Ridge Rd

Sarasota, FL 34243

(941) 312-2024

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#014960

Greenberg Dental &

Orthodontics-Bradenton

8754 E. State Road 70 Ste 8752

Bradenton, FL 34202

(941) 702-2229

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-Th 8am-4pm

S 7am - 2pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

PROSTHODONTICS

#010860

Great Expressions Dental Centers

11215 E State Road 70

Lakewood Ranch, FL 34202

(941) 757-0490

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN22473 Dinse, William

NPI: 1487645164 LIC: DN22473

CERTIFICATIONS :

MARION COUNTY

DENTIST

#020722

Dental Team of Ocala

3235 Sw 34Th Street Ste 103

Ocala, FL 34474

(352) 512-0733

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W 9am-5pm,

# DN15287 Fernandez, Jessica

NPI: 1891825709 LIC: DN15287

CERTIFICATIONS :

• Inhalation Sedation

#011112

Dental Team of Ocala, West

8750 Sw Hwy 200, Ste 101

Ocala, FL 34481

(352) 840-7077

Special Needs: No

English, Spanish

M 9am - 5pm,

W-Th 9am-5pm

# DN15063 Sanchez, Julio

NPI: 1932266210 LIC: DN15063

CERTIFICATIONS :

#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

CERTIFICATIONS :

#016114

Greenberg Dental & Orthodontics

3131 Sw College Rd, Ste 202

Ocala, FL 34474

(352) 414-1560

Special Needs: Yes

English, Spanish, Vietnamese

M-T 7am-4pm

W-F 7am-4pm

S 9am - 11am

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

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 115 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#016115

Greenberg Dental & Orthodontics

4901 E. Silver Springs Blvd, Ste 600

Ocala, FL 34470

(352) 559-2764

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 4pm,

W 8am-4pm,

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

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 116 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#011113

Healthy Smiles

3200 Sw 34Th Ave, Ste #401

Ocala, FL 34474

www.healthysmilesocala.com

(352) 732-5437

Special Needs: No

English, Spanish, Portuguese

M-T 8am-4pm

W-Th 8am-4pm

# DN18920 Rick, Adriana

NPI: 1851609002 LIC: DN18920

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

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 117 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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

#016514

Ur-Smile Dental

1110 Se 18Th Place Ste 200

Ocala, FL 34471

(352) 571-6030

Special Needs: Yes

English, Arabic

M-T 8am-5pm

W-F 8am-5pm

# DN21167 Al Hadithi, Mohammed

NPI: 1992196828 LIC: DN21167

CERTIFICATIONS :

ENDODONTICS

#016114

Greenberg Dental & Orthodontics

3131 Sw College Rd, Ste 202

Ocala, FL 34474

(352) 414-1560

Special Needs: Yes

English, Spanish, Vietnamese

M-T 7am-4pm

W-F 7am-4pm

S 9am - 11am

# DN19321 Bienias, Russell

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#016115

Greenberg Dental & Orthodontics

4901 E. Silver Springs Blvd, Ste 600

Ocala, FL 34470

(352) 559-2764

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 4pm,

W 8am-4pm,

# DN19321 Bienias, Russell

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN5060 Schwartz II, William

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#022670

North Central Florida Endodontics

48 Se 16Th Ave

Ocala, FL 34471

(352) 629-5898

Special Needs: No

M-T 8am-5pm

W-F 8am-5pm

# DN5901 Goldfaden, Stephen

NPI: 1417014457 LIC: DN5901

CERTIFICATIONS :

• Inhalation Sedation

# DN23014 Natera-Fernandez,

Marianella

NPI: 1073061297 LIC: DN23014

CERTIFICATIONS :

ORAL SURGEON

#016114

Greenberg Dental & Orthodontics

3131 Sw College Rd, Ste 202

Ocala, FL 34474

(352) 414-1560

Special Needs: Yes

English, Spanish, Vietnamese

M-T 7am-4pm

W-F 7am-4pm

S 9am - 11am

# DN19573 Adams, Bryan

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#016115

Greenberg Dental & Orthodontics

4901 E. Silver Springs Blvd, Ste 600

Ocala, FL 34470

(352) 559-2764

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 118 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 4pm,

W 8am-4pm,

# DN19573 Adams, Bryan

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#016114

Greenberg Dental & Orthodontics

3131 Sw College Rd, Ste 202

Ocala, FL 34474

(352) 414-1560

Special Needs: Yes

English, Spanish, Vietnamese

M-T 7am-4pm

W-F 7am-4pm

S 9am - 11am

# DN17521 Aaron, Scott

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#016115

Greenberg Dental & Orthodontics

4901 E. Silver Springs Blvd, Ste 600

Ocala, FL 34470

(352) 559-2764

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 4pm,

W 8am-4pm,

# DN17521 Aaron, Scott

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#016114

Greenberg Dental & Orthodontics

3131 Sw College Rd, Ste 202

Ocala, FL 34474

(352) 414-1560

Special Needs: Yes

English, Spanish, Vietnamese

M-T 7am-4pm

W-F 7am-4pm

S 9am - 11am

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#016115

Greenberg Dental & Orthodontics

4901 E. Silver Springs Blvd, Ste 600

Ocala, FL 34470

(352) 559-2764

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 4pm,

W 8am-4pm,

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

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 119 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#016114

Greenberg Dental & Orthodontics

3131 Sw College Rd, Ste 202

Ocala, FL 34474

(352) 414-1560

Special Needs: Yes

English, Spanish, Vietnamese

M-T 7am-4pm

W-F 7am-4pm

S 9am - 11am

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#016115

Greenberg Dental & Orthodontics

4901 E. Silver Springs Blvd, Ste 600

Ocala, FL 34470

(352) 559-2764

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 4pm,

W 8am-4pm,

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

PROSTHODONTICS

#016114

Greenberg Dental & Orthodontics

3131 Sw College Rd, Ste 202

Ocala, FL 34474

(352) 414-1560

Special Needs: Yes

English, Spanish, Vietnamese

M-T 7am-4pm

W-F 7am-4pm

S 9am - 11am

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#016115

Greenberg Dental & Orthodontics

4901 E. Silver Springs Blvd, Ste 600

Ocala, FL 34470

(352) 559-2764

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 4pm,

W 8am-4pm,

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

MARTIN COUNTY

DENTIST

#013585

Dentalworks Studio Of Indiantown

15275 Sw Adams Ave

Indiantown, FL 34956

(772) 597-4627

Special Needs: Yes

Spanish, English

M-T 9am-5pm

W-F 9am-5pm

# DN18835 Ortega Perez, Claudia

NPI: 1043543606 LIC: DN18835

CERTIFICATIONS :

#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 :

#010858

Great Expressions Dental Centers

3251 Nw Federal Highway

Jensen Beach, FL 34957

(772) 692-1447

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18775 Luba, Kevin

NPI: 1801040399 LIC: DN18775

CERTIFICATIONS :

# DN22051 Sonchaiwanich, Keith

NPI: 1790137859 LIC: DN22051

CERTIFICATIONS :

#010868

Great Expressions Dental Centers

6035 Se Federal Hwy

Stuart, FL 34997

(772) 223-4003

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN24133 Brandao, Pamela

NPI: 1164080495 LIC: DN24133

CERTIFICATIONS :

# DN22051 Sonchaiwanich, Keith

NPI: 1790137859 LIC: DN22051

CERTIFICATIONS :

# DN23412 Vuong, Wei Yin

NPI: 1639662174 LIC: DN23412

CERTIFICATIONS :

#016287

Great Expressions Dental Centers

2410 Nw Federal Hwy, Ste A-110

Stuart, FL 34994

(772) 692-4002

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN24133 Brandao, Pamela

NPI: 1164080495 LIC: DN24133

CERTIFICATIONS :

# DN23108 Farrah, Rose

NPI: 1588169254 LIC: DN23108

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 120 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#019581

Stuart Dental, Inc

424 Colorado Ave

Stuart, FL 34994

(772) 286-2124

Special Needs: Yes

English

M-T 8am-5pm

W 8am-5pm, Th 8am-4pm

# DN13088 Hibbert, Conrad

NPI: 1245448307 LIC: DN13088

CERTIFICATIONS :

#019555

Stuart Pediatric Dentistry

900 Se Ocean Blvd Ste B-118

Stuart, FL 34994

www.stuartpediatricdentistry.com

(772) 600-5130

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18580 Patel, Shekha*

NPI: 1023267887 LIC: DN18580

CERTIFICATIONS :

• Inhalation Sedation

ENDODONTICS

#010868

Great Expressions Dental Centers

6035 Se Federal Hwy

Stuart, FL 34997

(772) 223-4003

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21531 Marschall, Annika

NPI: 1528370798 LIC: DN21531

CERTIFICATIONS :

# DN14230 Zeim, Jason

NPI: 1760498422 LIC: DN14230

CERTIFICATIONS :

ORAL SURGEON

#010858

Great Expressions Dental Centers

3251 Nw Federal Highway

Jensen Beach, FL 34957

(772) 692-1447

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN22442 Turner, Mark

NPI: 1003252685 LIC: DN22442

CERTIFICATIONS :

• Inhalation Sedation

#016287

Great Expressions Dental Centers

2410 Nw Federal Hwy, Ste A-110

Stuart, FL 34994

(772) 692-4002

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN22442 Turner, Mark

NPI: 1003252685 LIC: DN22442

CERTIFICATIONS :

• Inhalation Sedation

PEDIATRIC DENTISTRY

#010858

Great Expressions Dental Centers

3251 Nw Federal Highway

Jensen Beach, FL 34957

(772) 692-1447

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20688 Acheampong, Emmanuel

NPI: 1407122252 LIC: DN20688

CERTIFICATIONS :

• Inhalation Sedation

#010868

Great Expressions Dental Centers

6035 Se Federal Hwy

Stuart, FL 34997

(772) 223-4003

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20688 Acheampong, Emmanuel

NPI: 1407122252 LIC: DN20688

CERTIFICATIONS :

• Inhalation Sedation

#016287

Great Expressions Dental Centers

2410 Nw Federal Hwy, Ste A-110

Stuart, FL 34994

(772) 692-4002

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN20688 Acheampong, Emmanuel

NPI: 1407122252 LIC: DN20688

CERTIFICATIONS :

• Inhalation Sedation

#019555

Stuart Pediatric Dentistry

900 Se Ocean Blvd Ste B-118

Stuart, FL 34994

www.stuartpediatricdentistry.com

(772) 600-5130

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18887 Matos, Luis*

NPI: 1619295771 LIC: DN18887

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

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 121 of 295

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 CHILD

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 :

#006640

Advanced Center for Cosmetic &

Implant Dentistry

8501 Sw 124 Ave Ste 107

Miami, FL 33183

(305) 279-9005

Special Needs: No

Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN12287 Cascante, Oscar

NPI: 1699880187 LIC: DN12287

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 :

#008236

Aldo Lujan Jr, DDS

8500 W. Flager St, Ste B

Miami, FL 33144

(305) 480-8353

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN14979 Lujan, Aldo

NPI: 1730222464 LIC: DN14979

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 :

#013501

All Smiles General Dentistry

12404 W. Dixie Hwy

North Miami, FL 33161

(305) 893-4801

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 9am-5pm

W-F 9am-5pm

S 9am - 5pm

# DN19628 Bernkrant, Shanna

NPI: 1366730236 LIC: DN19628

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

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 122 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#012297

American Pediatric Dental Group

Doral

7950 Nw 53Rd Street, Suitte 200

Doral, FL 33166

(305) 748-4999

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18955 Agrawal, Ankur

NPI: 1659697415 LIC: DN18955

CERTIFICATIONS :

• Inhalation Sedation

# DN19603 Frand, Joel

NPI: 1568675866 LIC: DN19603

CERTIFICATIONS :

• Inhalation Sedation

# DN21518 Mejia Valencia, Ana

NPI: 1073942629 LIC: DN21518

CERTIFICATIONS :

• Inhalation Sedation

# DN20294 Slement, Gaby

NPI: 1003244179 LIC: DN20294

CERTIFICATIONS :

• Inhalation Sedation

# DN21826 Vegas, Gabriela

NPI: 1407273881 LIC: DN21826

CERTIFICATIONS :

• Inhalation Sedation

# DN22896 Yazaji, Roula

NPI: 1669995684 LIC: DN22896

CERTIFICATIONS :

• Inhalation Sedation

#015847

American Pediatric Dental Group

Kendall

8200 Sw 117Th St, Ste 204

Miami, FL 33183

(786) 472-2447

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18955 Agrawal, Ankur

NPI: 1659697415 LIC: DN18955

CERTIFICATIONS :

• Inhalation Sedation

# DN19603 Frand, Joel

NPI: 1568675866 LIC: DN19603

CERTIFICATIONS :

• Inhalation Sedation

# DN21518 Mejia Valencia, Ana

NPI: 1073942629 LIC: DN21518

CERTIFICATIONS :

• Inhalation Sedation

# DN20294 Slement, Gaby

NPI: 1003244179 LIC: DN20294

CERTIFICATIONS :

• Inhalation Sedation

# DN21826 Vegas, Gabriela

NPI: 1407273881 LIC: DN21826

CERTIFICATIONS :

• Inhalation Sedation

# DN22896 Yazaji, Roula

NPI: 1669995684 LIC: DN22896

CERTIFICATIONS :

• Inhalation Sedation

#008932

Ana Maderal-Cozad D.D.S.

7725 N.W. 146Th St

Miami Lakes, FL 33016

(305) 827-9148

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN11484 Maderal-Cozad, Ana*

NPI: 1457476046 LIC: DN11484

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

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 5pm

# DN14173 Bobadilla, Patricia

NPI: 1124039672 LIC: DN14173

CERTIFICATIONS :

#006604

Balmir-Thevenin & Associates

10621 N. Kendall Dr. Ste 102

Miami, FL 33176

www.balmir-theveninandassociates.co

(305) 271-0510

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

M-T 9am-5pm

W-Th 9am-5pm

# DN13260 Balmir-Thevenin, Joelle

NPI: 1972618361 LIC: DN13260

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 :

#009841

Best Smile Dental

1380 Ne Miami Gardens Dr Ste 132

Miami, FL 33179

(786) 517-6127

Special Needs: Yes

English, Spanish

M-T 8am-3pm

W-F 8am-3pm

S 8am - 1pm

# DN16229 Vidal, Maria

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 123 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1780749473 LIC: DN16229

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 :

#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

Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN14776 Rey, Cecilia

NPI: 1588872006 LIC: DN14776

CERTIFICATIONS :

#016291

Cesar Palomeque DMD PA

1111 Sw 8Th Street, Ste 211

Miami, FL 33130

(305) 856-9837

Special Needs: No

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN11333 Palomeque, Cesar

NPI: 1093033896 LIC: DN11333

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

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 124 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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

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 125 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#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

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

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 126 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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

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 127 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

# 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 :

#007804

Design A Smile

6437 Bird Rd

Miami, FL 33155

(305) 667-8887

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 9am - 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 128 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W 9am-5pm, Th 9am-6pm,F 9am-1pm

# DN14151 Romay, Ricardo

NPI: 1720095037 LIC: DN14151

CERTIFICATIONS :

#017969

Design A Smile Kendall PA

13091 Sw 88Th St

Miami, FL 33186

(305) 408-3388

Special Needs: No

English, Spanish

M 9am - 5pm, T 9am - 6pm

W 9am-5pm, Th 9am-6pm,F 9am-1pm

# DN14151 Romay, Ricardo

NPI: 1720095037 LIC: DN14151

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 :

#008970

Doral Dental Partners

10620 Nw 19Th Street

Doral, FL 33172

(786) 331-7055

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN12295 Collazo, Ralph

NPI: 1720155955 LIC: DN12295

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 :

#013215

EGil Dental Corp

9950 Sw 107Th Ave, Ste 201

Miami, FL 33176

(305) 595-4397

Special Needs: Yes

Spanish, English

M-T 9am-5pm

W-Th 9am-5pm

# DN19789 Gil Araujo, Eduardo

NPI: 1841553112 LIC: DN19789

CERTIFICATIONS :

#019646

Elite Dent

12538 Sw 120Th St

Miami, FL 33186

(305) 646-6700

Special Needs: No

English

M-T 9am-5pm

W-Th 9am-5pm

# DN17602 Correa, Jacqueline

NPI: 1053516732 LIC: DN17602

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

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 129 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

2030 Nw 22Nd Ave

Miami, FL 33142

(305) 631-2963

Special Needs: No

English, Spanish

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 :

#019685

Erin E. Muro, DMD, PA

13550 Sw 120 Street Ste 512

Miami, FL 33186

(305) 380-7000

Special Needs: No

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN23663 Muro, Erin

NPI: 1588155253 LIC: DN23663

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 :

#012883

Evolution Smiles

340 Alhambra Circle

Coral Gables, FL 33134

(305) 442-6422

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-8pm, Th 8am-5pm,F 8am-2pm

# DN19902 Ayala, Diana

NPI: 1053669077 LIC: DN19902

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

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 130 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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

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 131 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#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 :

#007995

Family Dental

2260 Sw 8Th St, Ste 201

Miami, FL 33135

(305) 631-1998

Special Needs: Yes

Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN17580 Franco, Elba

NPI: 1013018191 LIC: DN17580

CERTIFICATIONS :

#006663

Fausto Nicieza, DMD PA

1491 E. 4Th Ave

Hialeah, FL 33010

(305) 888-8260

Special Needs: Yes

Spanish

M-T 10am-6pm

W-Th 10am-6pm

# DN17069 Pupo, Yusimy

NPI: 1962604835 LIC: DN17069

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

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 132 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(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 :

# 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 :

#009432

Franklin Casthely D.D.S.

160 Northeast 82Nd Street

Miami, FL 33138

(305) 756-7602

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN8394 Casthely, Franklin

NPI: 1699802884 LIC: DN8394

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 :

#008297

Gables Dental Clinic

5450 Sw 8Th Street, Ste # 201

Coral Gables, FL 33134

(305) 444-9951

Special Needs: Yes

English, Spanish

M 8am - 5pm, T 10am - 6pm

W-Th 8am-5pm

# DN12939 Noy, Isabel

NPI: 1033212519 LIC: DN12939

CERTIFICATIONS :

#009185

Gables Dental Services

747 Ponce De Leon Blvd, Ste # 301

Coral Gables, FL 33134

(305) 448-1999

Special Needs: Yes

English, Spanish

M 12pm - 6pm, T 9am - 3pm

W 9am-5pm, Th 9am-3pm,F 9am-5pm

S 9am - 2pm

# DN14510 Roman, Maximo

NPI: 1801008933 LIC: DN14510

CERTIFICATIONS :

#012703

Gables Exceptional Smiles

299 Alhambra Cir Ste 208

Coral Gables, FL 33134

(305) 442-9499

Special Needs: Yes

English, Spanish

M 9am - 3pm, T 8am - 4pm

W 8am-6pm, Th 8am-4pm

# DN13149 Perez, Michael

NPI: 1770781569 LIC: DN13149

CERTIFICATIONS :

• Inhalation Sedation

#014224

Gables Family Dental

2990 Sw Coral Way

Miami, FL 33145

(305) 529-9295

Special Needs: Yes

English, Spanish

M-T 10am-5pm

W 10am-6pm, Th 10am-5pm,F

10am-4pm

S 10am - 2pm

# DN14672 Tobon-Angel, Elias

NPI: 1689794885 LIC: DN14672

CERTIFICATIONS :

#019336

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 133 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Gables Family Dental of

Allapattah

2955 Nw 17 Ave

Miami, FL 33142

(305) 504-5553

Special Needs: No

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 10am - 2pm

# DN14672 Tobon-Angel, Elias

NPI: 1689794885 LIC: DN14672

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 :

#013233

Georgina Mesa, DMD, PA

13550 Sw 120Th Street, Ste 512

Miami, FL 33186

(305) 380-7000

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN13428 Mesa, Georgina

NPI: 1376620344 LIC: DN13428

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 :

#007629

Great Expressions Dental Centers

2501 Sw 22Nd Street

Miami, FL 33145

(305) 858-2545

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN21839 Heredia Laurencio,

Abelardo

NPI: 1760809149 LIC: DN21839

CERTIFICATIONS :

# DN24247 Medina, Andre

NPI: 1215597695 LIC: DN24247

CERTIFICATIONS :

#007690

Great Expressions Dental Centers

17301 Nw 27Th Ave

Miami Gardens, FL 33056

(305) 624-1371

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN21396 Dagan, Shachar

NPI: 1447632542 LIC: DN21396

CERTIFICATIONS :

# DN24068 Porrata, Teresita

NPI: 1679000392 LIC: DN24068

CERTIFICATIONS :

# DN16102 Scott, Tessa

NPI: 1396821948 LIC: DN16102

CERTIFICATIONS :

# DN21238 Yanes, Marnie

NPI: 1407236052 LIC: DN21238

CERTIFICATIONS :

#010849

Great Expressions Dental Centers

11865 Sw 26Th Street, Ste C39

Miami, FL 33175

(305) 227-0600

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19020 De La Rua, Lissette

NPI: 1619297892 LIC: DN19020

CERTIFICATIONS :

#010850

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 134 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Great Expressions Dental Centers

20335 Old Cutler Rd, Ste 200

Miami, FL 33189

(305) 238-6777

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN21817 Ferrer Torres, Dario

NPI: 1750708129 LIC: DN21817

CERTIFICATIONS :

• Inhalation Sedation

# DN19974 Macagno, Jessica

NPI: 1356680342 LIC: DN19974

CERTIFICATIONS :

#010851

Great Expressions Dental Centers

7300 N Kendall Drive, Ste 110

Miami, FL 33156

(305) 670-4476

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-7pm

# DN14539 Carrillo, Catalina

NPI: 1457421711 LIC: DN14539

CERTIFICATIONS :

# DN19020 De La Rua, Lissette

NPI: 1619297892 LIC: DN19020

CERTIFICATIONS :

#010859

Great Expressions Dental Centers

13876 Sw 88Th Street

Miami, FL 33186

(305) 385-4215

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19020 De La Rua, Lissette

NPI: 1619297892 LIC: DN19020

CERTIFICATIONS :

#016228

Great Expressions Dental Centers

19913 Biscayne Blvd

Aventura, FL 33180

(305) 935-1400

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-7pm

S 8am - 1pm

# DN21396 Dagan, Shachar

NPI: 1447632542 LIC: DN21396

CERTIFICATIONS :

# 058109 Gonvcalves Cordero,

Jhezanuel Carolina

NPI: 1477979557 LIC: 058109

CERTIFICATIONS :

# DN22938 Sanchez, Diego

NPI: 1902329816 LIC: DN22938

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

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 :

#015500

Henao & Associates Dental Group

18300 Nw 62Nd Ave Ste 120

Hialeah, FL 33015

(305) 570-1777

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17090 Henao, Gloria

NPI: 1306003488 LIC: DN17090

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

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 135 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

#011298

Hialeah Square Dentistry

4186 W. 12Th Ave

Hialeah, FL 33012

(305) 556-6291

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21172 Romero-Melis, Mildred

NPI: 1467843383 LIC: DN21172

CERTIFICATIONS :

#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 :

#008229

Ignacio J. Iturralde, DMD, PA

5711 Sw 137 Ave

Miami, FL 33183

(305) 387-3232

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

S 9am - 1pm

# DN8709 Iturralde, Ignacio

NPI: 1619028644 LIC: DN8709

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

# 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 :

#011877

Jacqueline Ellis, DMD

5535 Nw 7Th Ave

Miami, FL 33127

(305) 757-7763

Special Needs: Yes

English, Creoles and Pidgins

English-based(other)

M-T 9am-3pm

W 9am-3pm,

S 9am - 12pm

# DN11584 Ellis, Jacqueline

NPI: 1740304542 LIC: DN11584

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 :

#008726

JCF Dental Services PA

7171 Coral Way, Ste 401

Miami, FL 33155

(305) 264-9191

Special Needs: Yes

English, Spanish

M 9am - 5pm,

W 9am-5pm,

# DN17732 Flores, Juan

NPI: 1548459803 LIC: DN17732

CERTIFICATIONS :

#FQHC018872

Jessie Trice Community Health

Center, Inc

217 Nw 15Th Street

Miami, FL 33136

(305) 637-6400

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 136 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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

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 137 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#008991

Juan M. Garcia D.D.S.

6450 West 21St Court Ste 300

Hialeah, FL 33016

(305) 821-2261

Special Needs: No

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN11815 Garcia, Juan

NPI: 1598858805 LIC: DN11815

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 :

#009813

L. Maria Bienes D.M.D., P.A.

3411 S.W. 107Th Ave

Miami, FL 33165

(305) 221-0301

Special Needs: Yes

English, Spanish

M-T 8am-8pm

W 8am-8pm, Th 8am-2pm

# DN11566 Bienes, Lissette

NPI: 1275673071 LIC: DN11566

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 :

#008242

Liana Puig, DDS, PA

720 Sw 58Th Ct.

Miami, FL 33144

(305) 266-0011

Special Needs: Yes

English, Spanish

M-T 10am-5pm

W-Th 10am-5pm

# DN15854 Puig, Liana

NPI: 1790016202 LIC: DN15854

CERTIFICATIONS :

• Inhalation Sedation

#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

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 138 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN18774 Lobaina, Yoan

NPI: 1245468131 LIC: DN18774

CERTIFICATIONS :

#012095

Luis M. Santamarina, D.M.D.

330 Sw 27Th Ave Ste 602

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 :

#006646

Madeleine Castellanos-Gonzalez,

DMD

2140 W. 68Th St, Ste 202

Hialeah, FL 33016

(305) 820-4080

Special Needs: Yes

Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN14504 Castellanos-Gonzalez,

Madeleine

NPI: 1487798930 LIC: DN14504

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 :

#008226

Maria Cristina Fernandez, DDS,

4830 South West 8Th Street

Coral Gables, FL 33134

www.mariacristinafernandezdds.com

(305) 446-1067

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN11069 Fernandez, Maria

NPI: 1790826683 LIC: DN11069

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 :

#009921

Miami Gardens Dental

4538 Nw 183Rd Street

Miami Gardens, FL 33055

(305) 625-8272

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN17100 Corrales-Iglesias, Luisa

NPI: 1861546277 LIC: DN17100

CERTIFICATIONS :

# DN22217 Echeverri, Jonathan

NPI: 1104371137 LIC: DN22217

CERTIFICATIONS :

# DN22282 Lora-Mejia, Marlene

NPI: 1841745320 LIC: DN22282

CERTIFICATIONS :

# DN20876 Perez, Indira

NPI: 1841694007 LIC: DN20876

CERTIFICATIONS :

# DN18717 Waich, Viviana

NPI: 1528290871 LIC: DN18717

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

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 139 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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

#011904

Mirtha Amador DMD, PA

357 Almeria Ave Ste 105

Coral Gables, FL 33134

(305) 569-9001

Special Needs: No

English, Spanish

M 8am - 4pm, T 8am - 5pm

W 8am-5pm, Th 8am-4pm

# DN13027 Amador, Mirtha

NPI: 1578940912 LIC: DN13027

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 140 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#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 :

#022163

Morell Dental of Kendall

11030 N. Kendall Drive, Ste 202B

Miami, FL 33176

(305) 549-8777

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 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 :

#006583

Namoff & Fernandez DMD, PA

8500 W. Flagler St, Ste A-101

Miami, FL 33144

(305) 552-5511

Special Needs: No

Spanish

M-T 8am-4pm

# DN13931 Fernandez, Aurelio

NPI: 1609880145 LIC: DN13931

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

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 :

#015448

Nayade Morell DMD PLLC

916 Sw 67Th Ave

Miami, FL 33144

MORELLDENTAL.COM

(305) 265-5811

Special Needs: No

English, Spanish

M-T 10am-7pm

W-Th 10am-7pm

S 9am - 1pm

# DN17626 Morell, Nayade

NPI: 1942396502 LIC: DN17626

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 :

#011398

Next Dental

16125 Ne 18Th Ave

North Miami Beach, FL 33162

(305) 949-2766

Special Needs: No

English, Creoles and Pidgins

English-based(other), French

M-T 9am-5pm

W-F 9am-5pm

# DN20102 Smith, Edwin

NPI: 1104263813 LIC: DN20102

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 141 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#015173

Nicklaus Children's Hospital

3601 Nw 107Th Ave Ste 300

Doral, FL 33178

(786) 624-3368

Special Needs: Yes

Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN13098 Ivanier-Temkin, Sandra

NPI: 1699955583 LIC: DN13098

CERTIFICATIONS :

• Inhalation Sedation

#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 :

#017313

Oramas Dental Center

440 West 65Th Street

Hialeah, FL 33012

(305) 456-6322

Special Needs: No

English, Spanish

M-T 9am-7pm

W 9am-4pm, Th 9am-7pm

# DN15467 Oramas, Diana

NPI: 1952613713 LIC: DN15467

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 :

#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

# DN22785 Rielo, Miguel

NPI: 1376079939 LIC: DN22785

CERTIFICATIONS :

# DN24236 Soca, Yanisleidy

NPI: 1124689955 LIC: DN24236

CERTIFICATIONS :

#016745

Pediatric Dental Center of

Biscayne Inc

557 Ne 81St St

Miami, FL 33138

(305) 456-2680

Special Needs: Yes

M-T 8am-5pm

W-F 8am-5pm

# DN17647 Bueno, Rosa

NPI: 1972649218 LIC: DN17647

CERTIFICATIONS :

• Inhalation Sedation

# DN12873 Cerrud, Ginette

NPI: 1720093412 LIC: DN12873

CERTIFICATIONS :

# DN13098 Ivanier-Temkin, Sandra

NPI: 1699955583 LIC: DN13098

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 142 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#010834

Pediatric Dental Center of

Homestead

925 Ne 30Th Terrace, Ste 302

Homestead, FL 33033

(305) 246-3800

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN17647 Bueno, Rosa

NPI: 1972649218 LIC: DN17647

CERTIFICATIONS :

• Inhalation Sedation

# DN12873 Cerrud, Ginette

NPI: 1720093412 LIC: DN12873

CERTIFICATIONS :

# DN13098 Ivanier-Temkin, Sandra

NPI: 1699955583 LIC: DN13098

CERTIFICATIONS :

• Inhalation Sedation

#007593

Pediatric Dental Centers of Miami

2645 Douglas Rd, Ste # 703

Miami, FL 33133

(305) 448-3228

Special Needs: Yes

English, Spanish

M-T 9am-4pm

W-Th 9am-4pm

# DN17647 Bueno, Rosa

NPI: 1972649218 LIC: DN17647

CERTIFICATIONS :

• Inhalation Sedation

# DN12873 Cerrud, Ginette

NPI: 1720093412 LIC: DN12873

CERTIFICATIONS :

# DN13098 Ivanier-Temkin, Sandra

NPI: 1699955583 LIC: DN13098

CERTIFICATIONS :

• Inhalation Sedation

#008306

Pedro Alvarez DDS and Associates,

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 :

#022133

RC Dental

12305 Sw 112 Street

Miami, FL 33186

(305) 596-0322

Special Needs: No

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN21812 Cabrera, Rene

NPI: 1518313675 LIC: DN21812

CERTIFICATIONS :

#017261

Renata Kleiner-Pastoriza DDS PA

9654 Sw 72 St

Miami, FL 33173

(305) 598-3704

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 143 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

#014336

RGD Dental Corp

11870 Hialeah Gardens Blvd Sutie

129A

Hialeah, FL 33018

www.rgddentalcare.com

(786) 536-7537

Special Needs: No

English, Spanish

M 12pm - 8pm, T 9am - 6pm

W 12pm-8pm, Th 9am-6pm,F

9am-2pm

S 9am - 2pm

# DN19923 Gonzalez, Reydel

NPI: 1225385370 LIC: DN19923

CERTIFICATIONS :

#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

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 :

#016142

Rosario G. Molina, DMD

1909 Sw 27Th Ave

Miami, FL 33145

(305) 685-5133

Special Needs: Yes

English, Spanish

M-T 9am-6pm

# DN9515 Molina, Rosario

NPI: 1912231549 LIC: DN9515

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 :

#007808

Royal Oaks Dental Partners, LLC

15502 Nw 77Th Court

Miami Lakes, FL 33016

(305) 822-7332

Special Needs: Yes

Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN11940 Bretos, Alexander

NPI: 1790893030 LIC: DN11940

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

#018220

Shirley F. Simmonds, DMD PA

9000 Sw 152Nd Street, Ste 208

Miami, FL 33157

(305) 253-7670

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 144 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English

M-T 9am-5pm

W-Th 9am-5pm

# DN13171 Simmonds, Shirley

NPI: 1538299185 LIC: DN13171

CERTIFICATIONS :

#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 :

#013826

Smile Dentistry Associates

6741 Sw 24St Street, Ste 14

Miami, FL 33155

(305) 270-5505

Special Needs: No

Spanish, English

T 9am - 6pm

W-Th 9am-6pm

S 9am - 3pm

# DN11024 Alvarez, Pablo

NPI: 1265765655 LIC: DN11024

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 :

#017138

Smile Solutions Dental Group

8200 W. 33Rd Ave Ste 5

Hialeah, FL 33018

(305) 640-5501

Special Needs: No

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 :

#008732

South Dade Family Dentistry

18543 S. Dixie Hwy

Cutler Bay, FL 33157

(305) 259-9130

Special Needs: No

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

S 10am - 2pm

# DN13451 Corpas, Alfredo

NPI: 1124115837 LIC: DN13451

CERTIFICATIONS :

# DN18770 Trujillo, Madelene

NPI: 1881835767 LIC: DN18770

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

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

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 145 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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

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 146 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#008254

Sunset Smiles Dental Office

8585 Sw 72Nd St, Ste # 101

Miami, FL 33143

www.sunsetsmilesdental.com

(305) 270-0171

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W 8am-4pm, Th 9am-6pm,F 8am-1pm

# DN16743 Hidalgo-Gonzalez,

Allison

NPI: 1497814503 LIC: DN16743

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 :

#011271

The Little Tooth Doctor Doral

10717 Nw 58 Street

Doral, FL 33178

(305) 513-4058

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN20069 Acosta, Damian

NPI: 1821432162 LIC: DN20069

CERTIFICATIONS :

# DN13558 Garrastazu, Juan

NPI: 1043382138 LIC: DN13558

CERTIFICATIONS :

• Inhalation Sedation

#011272

The Little Tooth Doctor Kendall

13757 Sw 152 Street

Miami, FL 33177

(305) 251-5390

Special Needs: Yes

English, Spanish

M-T 9am-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 147 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W-F 9am-5pm

# DN20069 Acosta, Damian

NPI: 1821432162 LIC: DN20069

CERTIFICATIONS :

# DN13558 Garrastazu, Juan

NPI: 1043382138 LIC: DN13558

CERTIFICATIONS :

• Inhalation Sedation

#021453

The Tooth Place

8 Palms Plz

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 :

#009798

Thomas Muro Jr. D.M.D., P.A

13550 Southwest 120Th Street, Ste

512

Miami, FL 33186

(305) 380-7000

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN13749 Muro Jr., Thomas

NPI: 1649344847 LIC: DN13749

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

#018995

Total Dental Family Care

15787 Sw 72Nd St

Miami, FL 33193

www.totaldentalfamilycare.com

(305) 505-3335

Special Needs: Yes

English, Spanish

M 9am - 6pm,

W-Th 9am-6pm

# DN21164 Rey, Tatiana

NPI: 1710378641 LIC: DN21164

CERTIFICATIONS :

#010646

Towncare Dental of Cutler Bay,

P.A.

20533 Old Cutler Road

Miami, FL 33189

(305) 233-1118

Special Needs: No

English, Spanish

# DN19429 Caravia, Amanda

NPI: 1336427343 LIC: DN19429

CERTIFICATIONS :

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

#019644

TranscenDENTAL Studio

9275 Sw 152Nd St Ste 206

Miami, FL 33157

www.tdentalstudio.com

(305) 233-3922

Special Needs: Yes

T 8am - 5pm

W-F 8am-5pm

# DN22041 Mabjeesh, Jasmine

NPI: 1841643012 LIC: DN22041

CERTIFICATIONS :

#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

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 148 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#011655

VND Corp./Vivian Valdes, DDS

6840 Sw 40Th St Ste 207A

Miami, FL 33155

(305) 669-6111

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

S 8am - 2pm

# DN14228 Valdes-Garcia, Vivian

NPI: 1689681108 LIC: DN14228

CERTIFICATIONS :

• Inhalation Sedation

#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

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 :

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 149 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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

(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

#018443

Caring Dental Services, LLC

127 Nw 12Th Ave

Miami, FL 33128

(305) 325-1771

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

T 11am - 3pm

W 8am-2pm, Th 8am-4pm,F 8am-1pm

# DN22653 Lazo Quintana, Isarelys

NPI: 1841715950 LIC: DN22653

CERTIFICATIONS :

# DN11339 Phanord, Roger

NPI: 1265505515 LIC: DN11339

CERTIFICATIONS :

#015933

Cutler Bay Dental Specialty PLLC

20529 Old Cutler Rd

Cutler Bay, FL 33189

(786) 619-1159

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

# DN11671 Porras, Edgar

NPI: 1659467785 LIC: DN11671

CERTIFICATIONS :

#010762

Dental Associates of Homestead

925 Ne 30 Terrace, Ste 114

Homestead, FL 33033

(305) 247-0910

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15585 Posner, William

NPI: 1730203100 LIC: DN15585

CERTIFICATIONS :

#010673

Dental Center At Aventura

19086 Ne 29 Ave

Aventura, FL 33180

(305) 682-1554

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 8am - 5pm

W 9am-5pm, Th 8am-5pm,F 8am-3pm

# DN18596 Selman, Anas

NPI: 1134354491 LIC: DN18596

CERTIFICATIONS :

#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

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 150 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#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

# DN15585 Posner, William

NPI: 1730203100 LIC: DN15585

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

# DN15585 Posner, William

NPI: 1730203100 LIC: DN15585

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

# DN15585 Posner, William

NPI: 1730203100 LIC: DN15585

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 :

#007690

Great Expressions Dental Centers

17301 Nw 27Th Ave

Miami Gardens, FL 33056

(305) 624-1371

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19592 Mattos, Katia

NPI: 1003173386 LIC: DN19592

CERTIFICATIONS :

#010851

Great Expressions Dental Centers

7300 N Kendall Drive, Ste 110

Miami, FL 33156

(305) 670-4476

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-7pm

# DN19592 Mattos, Katia

NPI: 1003173386 LIC: DN19592

CERTIFICATIONS :

#016228

Great Expressions Dental Centers

19913 Biscayne Blvd

Aventura, FL 33180

(305) 935-1400

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-7pm

S 8am - 1pm

# DN19592 Mattos, Katia

NPI: 1003173386 LIC: DN19592

CERTIFICATIONS :

#013364

Hammocks Dental Center, PA

9280 Hammock Blvd, Ste #102

Miami, FL 33196

(305) 387-5700

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 151 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Spanish

M 12pm - 6pm, T 9am - 3pm

W 2pm-6pm, Th 12pm-6pm

S 10am - 1pm

# DN21526 Alvarez, Ariam

NPI: 1962841783 LIC: DN21526

CERTIFICATIONS :

#016407

Hialeah Dental Specialty

Associates, P.L.

900 W 49Th St Ste 400

Hialeah, FL 33012

(305) 558-1211

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

# DN8813 Knopf, Kenneth

NPI: 1700927126 LIC: DN8813

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

# 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 :

#010663

Miami Beach Center for Dental

Specialties, PA

333 Arthur Godfrey Road, Ste 818

Miami Beach, FL 33140

(305) 674-0095

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN15585 Posner, William

NPI: 1730203100 LIC: DN15585

CERTIFICATIONS :

# DN22214 Sarmiento, Jeffrey

NPI: 1184177560 LIC: DN22214

CERTIFICATIONS :

# DN18596 Selman, Anas

NPI: 1134354491 LIC: DN18596

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

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 152 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#010664

Palmetto Center for Dental

Specialties

7150 W 20Th Ave, Ste 102

Hialeah, FL 33016

(305) 556-5600

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN8490 Comora, Robert

NPI: 1699855361 LIC: DN8490

CERTIFICATIONS :

# DN18596 Selman, Anas

NPI: 1134354491 LIC: DN18596

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 :

#009435

Phanord & Associates, PA

1245 Nw 119Th St

North Miami, FL 33167

(305) 685-7863

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

M 9am - 6pm, T 9am - 4pm

W 9am-6pm, Th 9am-4pm,F 8am-1pm

# DN11339 Phanord, Roger

NPI: 1265505515 LIC: DN11339

CERTIFICATIONS :

#009996

Sabal Palm Dental Associates, P.A.

5337 Ne 2Nd Ave

Miami, FL 33137

www.phanord.com

(305) 758-0815

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French, Haitian;

Haitian Creole

M 9am - 4pm, T 10am - 4pm

# DN11339 Phanord, Roger

NPI: 1265505515 LIC: DN11339

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

# DN13421 Gittess, Robert

NPI: 1922137058 LIC: DN13421

CERTIFICATIONS :

#010646

Towncare Dental of Cutler Bay,

P.A.

20533 Old Cutler Road

Miami, FL 33189

(305) 233-1118

Special Needs: No

English, Spanish

# DN11671 Porras, Edgar

NPI: 1659467785 LIC: DN11671

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

#008914

AC Pediatric Dentistry

4410 W. 16Th Ave, Ste 52

Hialeah, FL 33012

(305) 825-9899

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN17696 Lopez, Juan

NPI: 1447281720 LIC: DN17696

CERTIFICATIONS :

• General Anesthesia

#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

#018686

Carlos J. Rodriguez-Feo, DDS, PA

6601 Sw 80Th St, Ste 125

Miami, FL 33143

www.jawsurgery.org

(305) 665-3721

Special Needs: Yes

English, Spanish

M-T 9am-4pm

W 9am-4pm, Th 9am-12pm,F

9am-4pm

# DN11350 Rodriguez-Feo, Carlos

NPI: 1023089950 LIC: DN11350

CERTIFICATIONS :

• General Anesthesia

#015933

Cutler Bay Dental Specialty PLLC

20529 Old Cutler Rd

Cutler Bay, FL 33189

(786) 619-1159

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

# DN17919 Hew, Damion

NPI: 1801060967 LIC: DN17919

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN15235 Saenz, Regina

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 153 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1417047218 LIC: DN15235

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#010762

Dental Associates of Homestead

925 Ne 30 Terrace, Ste 114

Homestead, FL 33033

(305) 247-0910

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN18521 Grider, Joseph

NPI: 1881895910 LIC: DN18521

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#010673

Dental Center At Aventura

19086 Ne 29 Ave

Aventura, FL 33180

(305) 682-1554

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 8am - 5pm

W 9am-5pm, Th 8am-5pm,F 8am-3pm

# DN20155 Oppenheimer, Eli

NPI: 1174866339 LIC: DN20155

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#010662

Dental Specialty Center at Baptist

8940 N. Kendall D, Ste 1001E

Miami, FL 33176

(305) 275-8875

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN18521 Grider, Joseph

NPI: 1881895910 LIC: DN18521

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN17919 Hew, Damion

NPI: 1801060967 LIC: DN17919

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN15235 Saenz, Regina

NPI: 1417047218 LIC: DN15235

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#007690

Great Expressions Dental Centers

17301 Nw 27Th Ave

Miami Gardens, FL 33056

(305) 624-1371

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN12418 Torres, Luis

NPI: 1801977582 LIC: DN12418

CERTIFICATIONS :

• General Anesthesia

#010851

Great Expressions Dental Centers

7300 N Kendall Drive, Ste 110

Miami, FL 33156

(305) 670-4476

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-7pm

# DN12418 Torres, Luis

NPI: 1801977582 LIC: DN12418

CERTIFICATIONS :

• General Anesthesia

#010663

Miami Beach Center for Dental

Specialties, PA

333 Arthur Godfrey Road, Ste 818

Miami Beach, FL 33140

(305) 674-0095

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN18521 Grider, Joseph

NPI: 1881895910 LIC: DN18521

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN15235 Saenz, Regina

NPI: 1417047218 LIC: DN15235

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015173

Nicklaus Children's Hospital

3601 Nw 107Th Ave Ste 300

Doral, FL 33178

(786) 624-3368

Special Needs: Yes

Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN19228 Borges, Osbel

NPI: 1518213388 LIC: DN19228

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN17503 Lozano, Teresa

NPI: 1760494678 LIC: DN17503

CERTIFICATIONS :

• Board Certification

• General Anesthesia

#010664

Palmetto Center for Dental

Specialties

7150 W 20Th Ave, Ste 102

Hialeah, FL 33016

(305) 556-5600

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17919 Hew, Damion

NPI: 1801060967 LIC: DN17919

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN15235 Saenz, Regina

NPI: 1417047218 LIC: DN15235

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#009284

Regina H. Saenz

3695 W. 4Th Ave

Hialeah, FL 33012

(786) 536-2767

Special Needs: Yes

Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15235 Saenz, Regina

NPI: 1417047218 LIC: DN15235

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#007768

Regina H. Saenz, DDS, PA

950 North Krome Ave, Ste 204

Homestead, FL 33030

(305) 245-6633

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15235 Saenz, Regina

NPI: 1417047218 LIC: DN15235

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#010646

Towncare Dental of Cutler Bay,

P.A.

20533 Old Cutler Road

Miami, FL 33189

(305) 233-1118

Special Needs: No

English, Spanish

# DN15235 Saenz, Regina

NPI: 1417047218 LIC: DN15235

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 154 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#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

# DN13470 Ramos, Gisleda

NPI: 1437204765 LIC: DN13470

CERTIFICATIONS :

#006663

Fausto Nicieza, DMD PA

1491 E. 4Th Ave

Hialeah, FL 33010

(305) 888-8260

Special Needs: Yes

Spanish

M-T 10am-6pm

W-Th 10am-6pm

# DN15528 Nicieza, Fausto

NPI: 1952418360 LIC: DN15528

CERTIFICATIONS :

#021662

Hodson & Meister, PA

18333 Ne 19Th Ave

Miami, FL 33179

www.nmbortho.com

(305) 974-6157

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 7pm

Th-F 8am-5pm

S 9am - 12pm

# DN21710 Hodson, Shane

NPI: 1841738200 LIC: DN21710

CERTIFICATIONS :

#021447

Juan de Dios Garcia, D.M.D.

7769 Nw 146Th St.

Hialeah, FL 33016

(305) 821-4777

Special Needs: No

English, Spanish

M-T 9am-5pm

W 10am-6pm, Th 9am-5pm,F

8am-2pm

# DN10860 Garcia, Juan De Dios

NPI: 1225201734 LIC: DN10860

CERTIFICATIONS :

#017015

Little Stars Dentistry of Miami

Shores

660 Ne 95Th St Unit C

Miami, FL 33138

(305) 754-5081

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other), French

M-T 9am-5pm

W-F 9am-5pm

S 9am - 3pm

# DN13832 Rodriguez, Luis

NPI: 1649202920 LIC: DN13832

CERTIFICATIONS :

• Inhalation Sedation

#016862

Miami Beach Orthodontics

925 Arthur Godfrey Road Ste 300

Miami Beach, FL 33140

www.miamibeachorthodontics.com

(305) 672-2260

Special Needs: Yes

English, Spanish, Hebrew

M-T 9am-5pm

W-Th 9am-5pm

# DN19109 Rubensteen, Evan

NPI: 1780999003 LIC: DN19109

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

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#015173

Nicklaus Children's Hospital

3601 Nw 107Th Ave Ste 300

Doral, FL 33178

(786) 624-3368

Special Needs: Yes

Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN17512 Alquizar, Pedro

NPI: 1164689311 LIC: DN17512

CERTIFICATIONS :

# DN17079 Briceno, Carmen

NPI: 1598917387 LIC: DN17079

CERTIFICATIONS :

• Board Certification

#016745

Pediatric Dental Center of

Biscayne Inc

557 Ne 81St St

Miami, FL 33138

(305) 456-2680

Special Needs: Yes

M-T 8am-5pm

W-F 8am-5pm

# DN13470 Ramos, Gisleda

NPI: 1437204765 LIC: DN13470

CERTIFICATIONS :

#010834

Pediatric Dental Center of

Homestead

925 Ne 30Th Terrace, Ste 302

Homestead, FL 33033

(305) 246-3800

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN13470 Ramos, Gisleda

NPI: 1437204765 LIC: DN13470

CERTIFICATIONS :

#007593

Pediatric Dental Centers of Miami

2645 Douglas Rd, Ste # 703

Miami, FL 33133

(305) 448-3228

Special Needs: Yes

English, Spanish

M-T 9am-4pm

W-Th 9am-4pm

# DN13470 Ramos, Gisleda

NPI: 1437204765 LIC: DN13470

CERTIFICATIONS :

#017181

Rodriguez Orthodontics

4695 W. 4Th Ave

Hialeah, FL 33012

www.rodriguezorthodonitics.com

(305) 825-8888

Special Needs: No

English, Creoles and Pidgins

French-based(other), French

M-T 9am-6pm

W-F 9am-6pm

S 9am - 1pm

# DN13832 Rodriguez, Luis

NPI: 1649202920 LIC: DN13832

CERTIFICATIONS :

• Inhalation Sedation

#009753

Southland Mall Dental

20505 S. Dixie Hwy Ste 1683

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 155 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Miami, FL 33189

(305) 232-3737

Special Needs: Yes

English, Spanish

M-T 10am-9pm

W-F 10am-9pm

S-Su 10am-6pm

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#020544

Specialty Smiles

16375 Nw 67Th Ave

Miami Lakes, FL 33014

(305) 822-6784

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

CERTIFICATIONS :

#021139

Specialty Smiles

1245 Nw 119Th St.

Miami, FL 33167

(305) 822-6784

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

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

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#008914

AC Pediatric Dentistry

4410 W. 16Th Ave, Ste 52

Hialeah, FL 33012

(305) 825-9899

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN16674 Cabrerizo, Ania

NPI: 1154490373 LIC: DN16674

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21702 Del Toro, Lizza

NPI: 1053381988 LIC: DN21702

CERTIFICATIONS :

• Inhalation Sedation

# DN22180 Puig, Christina

NPI: 1679954788 LIC: DN22180

CERTIFICATIONS :

• Inhalation Sedation

# DN21093 Rodriguez, Hilma

NPI: 1699115048 LIC: DN21093

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21626 Roman, Celia

NPI: 1356570303 LIC: DN21626

CERTIFICATIONS :

# DN20633 Solarte, Marcela

NPI: 1346608478 LIC: DN20633

CERTIFICATIONS :

• Inhalation Sedation

# DN17706 Tejeda, Dayrys

NPI: 1558524876 LIC: DN17706

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

#016406

AC Pediatric Dentistry

2950 Sw 8Th Street

Miami, FL 33135

(305) 456-9417

Special Needs: Yes

English

M-T 9am-5pm

W-F 9am-5pm

# DN16674 Cabrerizo, Ania

NPI: 1154490373 LIC: DN16674

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21702 Del Toro, Lizza

NPI: 1053381988 LIC: DN21702

CERTIFICATIONS :

• Inhalation Sedation

# DN22180 Puig, Christina

NPI: 1679954788 LIC: DN22180

CERTIFICATIONS :

• Inhalation Sedation

# DN21093 Rodriguez, Hilma

NPI: 1699115048 LIC: DN21093

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21626 Roman, Celia

NPI: 1356570303 LIC: DN21626

CERTIFICATIONS :

# DN20633 Solarte, Marcela

NPI: 1346608478 LIC: DN20633

CERTIFICATIONS :

• Inhalation Sedation

# DN17706 Tejeda, Dayrys

NPI: 1558524876 LIC: DN17706

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

#011302

ADC Miller Square, P.L.

13840 S.W. 56Th Street

Miami, FL 33175

(305) 385-3338

Special Needs: Yes

English

M 12pm - 7pm, T 9am - 6pm

S 9am - 12pm

# DN14474 Ortiz-Perez, Marta

NPI: 1194883835 LIC: DN14474

CERTIFICATIONS :

• Inhalation Sedation

#011086

Altima Dental Group of West

Kendall, LLC

16371 Sw 88Th Street

Miami, FL 33196

(305) 380-8773

Special Needs: Yes

English, Chinese Mandarin, Greek

Modern(1453-), Hebrew, Portuguese,

Spanish

M-T 9am-6pm

W-F 9am-6pm

S 8am - 2pm

# DN13649 Azar, Francisco

NPI: 1679671713 LIC: DN13649

CERTIFICATIONS :

• Inhalation Sedation

# DN16953 Cortes, Gonzalo

NPI: 1740480417 LIC: DN16953

CERTIFICATIONS :

• Inhalation Sedation

#012297

American Pediatric Dental Group

Doral

7950 Nw 53Rd Street, Suitte 200

Doral, FL 33166

(305) 748-4999

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 156 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18730 Aza, Sara

NPI: 1386872521 LIC: DN18730

CERTIFICATIONS :

• Inhalation Sedation

# DN24237 Chardon, Yohayra

NPI: 1689063133 LIC: DN24237

CERTIFICATIONS :

# DN22409 Erazo, Nicole

NPI: 1760839278 LIC: DN22409

CERTIFICATIONS :

• Inhalation Sedation

# DN23165 Garber, Yamila

NPI: 1013376318 LIC: DN23165

CERTIFICATIONS :

# DN19743 Liou, Shasan

NPI: 1770848731 LIC: DN19743

CERTIFICATIONS :

• Inhalation Sedation

# DN18474 McCallum, Tamara

NPI: 1366607236 LIC: DN18474

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN23990 Nolte, Samantha

NPI: 1114342797 LIC: DN23990

CERTIFICATIONS :

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN17608 Pena, William

NPI: 1922246388 LIC: DN17608

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18321 Valiente, Lizette

NPI: 1851547863 LIC: DN18321

CERTIFICATIONS :

• Inhalation Sedation

#015847

American Pediatric Dental Group

Kendall

8200 Sw 117Th St, Ste 204

Miami, FL 33183

(786) 472-2447

Special Needs: Yes

English

M 9am - 6pm, T 8am - 5pm

W 8am-5pm, Th 9am-6pm,F 8am-5pm

S 8am - 1pm

# DN18730 Aza, Sara

NPI: 1386872521 LIC: DN18730

CERTIFICATIONS :

• Inhalation Sedation

# DN24237 Chardon, Yohayra

NPI: 1689063133 LIC: DN24237

CERTIFICATIONS :

# DN22409 Erazo, Nicole

NPI: 1760839278 LIC: DN22409

CERTIFICATIONS :

• Inhalation Sedation

# DN23165 Garber, Yamila

NPI: 1013376318 LIC: DN23165

CERTIFICATIONS :

# DN19743 Liou, Shasan

NPI: 1770848731 LIC: DN19743

CERTIFICATIONS :

• Inhalation Sedation

# DN18474 McCallum, Tamara

NPI: 1366607236 LIC: DN18474

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN23990 Nolte, Samantha

NPI: 1114342797 LIC: DN23990

CERTIFICATIONS :

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN17608 Pena, William

NPI: 1922246388 LIC: DN17608

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18321 Valiente, Lizette

NPI: 1851547863 LIC: DN18321

CERTIFICATIONS :

• Inhalation Sedation

#008931

Aventura Pediatric Dentistry

2797 Northeast 207Th Street Ste 201

Aventura, FL 33180

dentalcaregroupkids.com

(305) 935-1613

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 9am-5pm

Th-F 9am-5pm

S 9am - 12pm

# DN21373 Castellano, Alicia

NPI: 1134503428 LIC: DN21373

CERTIFICATIONS :

• Inhalation Sedation

# DN15089 Garcia, Kathy

NPI: 1972651719 LIC: DN15089

CERTIFICATIONS :

# DN19597 Rosenfeld, Dalia

NPI: 1134496037 LIC: DN19597

CERTIFICATIONS :

• Inhalation Sedation

#018443

Caring Dental Services, LLC

127 Nw 12Th Ave

Miami, FL 33128

(305) 325-1771

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

T 11am - 3pm

W 8am-2pm, Th 8am-4pm,F 8am-1pm

# DN14809 Jobson, Margot

NPI: 1609974039 LIC: DN14809

CERTIFICATIONS :

• Inhalation Sedation

#011085

Dental Center of Country Walk,

LLC

15795 Sw 152Nd Street

Miami, FL 33187

(305) 233-3335

Special Needs: Yes

English, Chinese Mandarin, Greek

Modern(1453-), Hebrew, Portuguese,

Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN13649 Azar, Francisco

NPI: 1679671713 LIC: DN13649

CERTIFICATIONS :

• Inhalation Sedation

# DN16953 Cortes, Gonzalo

NPI: 1740480417 LIC: DN16953

CERTIFICATIONS :

• Inhalation Sedation

#011084

Dental Center of Homestead

2870 Ne 8Th Street

Homestead, FL 33033

(305) 246-5444

Special Needs: Yes

English, Chinese Mandarin, Greek

Modern(1453-), Hebrew, Portuguese,

Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN13649 Azar, Francisco

NPI: 1679671713 LIC: DN13649

CERTIFICATIONS :

• Inhalation Sedation

# DN16953 Cortes, Gonzalo

NPI: 1740480417 LIC: DN16953

CERTIFICATIONS :

• Inhalation Sedation

#015969

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 157 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Francisco Javier Azar DDS, MPH,

16777 N Miami Ave

Miami, FL 33169

www.azardentistry.com

(305) 866-3030

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN13649 Azar, Francisco

NPI: 1679671713 LIC: DN13649

CERTIFICATIONS :

• Inhalation Sedation

#007629

Great Expressions Dental Centers

2501 Sw 22Nd Street

Miami, FL 33145

(305) 858-2545

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN18508 Le Bona, Daisy

NPI: 1235374471 LIC: DN18508

CERTIFICATIONS :

• Inhalation Sedation

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

CERTIFICATIONS :

• Inhalation Sedation

#007690

Great Expressions Dental Centers

17301 Nw 27Th Ave

Miami Gardens, FL 33056

(305) 624-1371

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN18508 Le Bona, Daisy

NPI: 1235374471 LIC: DN18508

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21778 Smith, Safiya

NPI: 1245623743 LIC: DN21778

CERTIFICATIONS :

• Inhalation Sedation

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

CERTIFICATIONS :

• Inhalation Sedation

#010849

Great Expressions Dental Centers

11865 Sw 26Th Street, Ste C39

Miami, FL 33175

(305) 227-0600

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN18508 Le Bona, Daisy

NPI: 1235374471 LIC: DN18508

CERTIFICATIONS :

• Inhalation Sedation

# DN19800 Pellerano, Paola

NPI: 1194152280 LIC: DN19800

CERTIFICATIONS :

• Inhalation Sedation

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

CERTIFICATIONS :

• Inhalation Sedation

#010850

Great Expressions Dental Centers

20335 Old Cutler Rd, Ste 200

Miami, FL 33189

(305) 238-6777

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN19800 Pellerano, Paola

NPI: 1194152280 LIC: DN19800

CERTIFICATIONS :

• Inhalation Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

CERTIFICATIONS :

• Inhalation Sedation

#010851

Great Expressions Dental Centers

7300 N Kendall Drive, Ste 110

Miami, FL 33156

(305) 670-4476

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-7pm

# DN18508 Le Bona, Daisy

NPI: 1235374471 LIC: DN18508

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

CERTIFICATIONS :

• Inhalation Sedation

#010857

Great Expressions Dental Centers

1001 Ives Dairy Road, Ste 103

Miami, FL 33179

(305) 652-3412

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN18508 Le Bona, Daisy

NPI: 1235374471 LIC: DN18508

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21778 Smith, Safiya

NPI: 1245623743 LIC: DN21778

CERTIFICATIONS :

• Inhalation Sedation

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

CERTIFICATIONS :

• Inhalation Sedation

#010859

Great Expressions Dental Centers

13876 Sw 88Th Street

Miami, FL 33186

(305) 385-4215

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN18508 Le Bona, Daisy

NPI: 1235374471 LIC: DN18508

CERTIFICATIONS :

• Inhalation Sedation

# DN20174 Suta, Adi

NPI: 1457791816 LIC: DN20174

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 158 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#017205

Great Expressions Dental Centers

18835 Biscayne Blvd, Ste 180

Miami, FL 33180

(305) 570-3978

Special Needs: Yes

English

M-T 8am-5pm

W-F 11am-7pm

# DN20210 Abarca, Marvin

NPI: 1316388820 LIC: DN20210

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN20205 Stephens, Wayne

NPI: 1649679085 LIC: DN20205

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,

# DN20205 Stephens, Wayne

NPI: 1649679085 LIC: DN20205

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

# DN20205 Stephens, Wayne

NPI: 1649679085 LIC: DN20205

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

# DN20205 Stephens, Wayne

NPI: 1649679085 LIC: DN20205

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

# DN20205 Stephens, Wayne

NPI: 1649679085 LIC: DN20205

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

# DN20205 Stephens, Wayne

NPI: 1649679085 LIC: DN20205

CERTIFICATIONS :

• Inhalation Sedation

#012437

Little Smiles Dental #2

10205 S Dixie Hwy Ste 200 & 201

Pinecrest, FL 33156

(305) 279-4312

Special Needs: Yes

Spanish, English

M-T 9am-4pm

W-F 9am-4pm

# DN15894 Cortes, Bayardo

NPI: 1174604896 LIC: DN15894

CERTIFICATIONS :

• Inhalation Sedation

#011317

Little Smiles Dental Office

15495 Eagle Nest Lane, Ste 110

Miami Lakes, FL 33014

www.littlesmilesdentalFLA.com

(305) 698-7566

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15894 Cortes, Bayardo

NPI: 1174604896 LIC: DN15894

CERTIFICATIONS :

• Inhalation Sedation

#017015

Little Stars Dentistry of Miami

Shores

660 Ne 95Th St Unit C

Miami, FL 33138

(305) 754-5081

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other), French

M-T 9am-5pm

W-F 9am-5pm

S 9am - 3pm

# DN23165 Garber, Yamila

NPI: 1013376318 LIC: DN23165

CERTIFICATIONS :

# DN20908 Mutawalli, Khalid

NPI: 1750754818 LIC: DN20908

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN14474 Ortiz-Perez, Marta

NPI: 1194883835 LIC: DN14474

CERTIFICATIONS :

• Inhalation Sedation

#012195

Maigrely Abreu-Hernandez DMD

5965 Ponce De Leon Blvd

Coral Gables, FL 33146

www.casasmiles.com

(305) 662-7702

Special Needs: Yes

English, Spanish

M 9am - 6pm, T 8am - 6pm

W 9am-6pm, Th 8am-6pm,F

8am-12pm

# DN17910 Abreu-Hernandez,

Maigrely*

NPI: 1891993101 LIC: DN17910

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN8363 Llamas, Luis*

NPI: 1659595106 LIC: DN8363

CERTIFICATIONS :

# DN17881 Nazario Lugo, Beatriz*

NPI: 1255340279 LIC: DN17881

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 159 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#013906

Maigrely Abreu-Hernandez DMD

240 Crandon Blvd Ste 105

Key Biscayne, FL 33149

www.casasmiles.com

(305) 662-7702

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN17910 Abreu-Hernandez,

Maigrely*

NPI: 1891993101 LIC: DN17910

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN8363 Llamas, Luis*

NPI: 1659595106 LIC: DN8363

CERTIFICATIONS :

# DN17881 Nazario Lugo, Beatriz*

NPI: 1255340279 LIC: DN17881

CERTIFICATIONS :

• Inhalation Sedation

#013704

Main St Children's Dentistry &

Orthodontics of Miami Beach

4308 Alton Rd Ste 930

Miami Beach, FL 33140

(305) 921-4601

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN23247 Echeverria, Laura

NPI: 1538528914 LIC: DN23247

CERTIFICATIONS :

# DN18852 Krajewski, Helena

NPI: 1356670988 LIC: DN18852

CERTIFICATIONS :

• Inhalation Sedation

#011301

Main Street Children's Dentistry

& Orthodontics of Homestead

925 Ne 30 Terrace, Stes #110

Homestead, FL 33033

(305) 245-0236

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 9am - 6pm

W-F 9am-5pm

# DN19957 Coro, Mabel

NPI: 1053547703 LIC: DN19957

CERTIFICATIONS :

• Inhalation Sedation

# DN23247 Echeverria, Laura

NPI: 1538528914 LIC: DN23247

CERTIFICATIONS :

#011299

Main Street Childrens Dentistry

at Palmetto Hospital

7150 W 20Th Ave, Ste 103

Hialeah, FL 33016

(305) 556-9020

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15204 Martinez, Aicmee

NPI: 1467540591 LIC: DN15204

CERTIFICATIONS :

• Inhalation Sedation

#011700

Main Street Children's Dentistry

of Aventura, PA

19084 Ne 29Th Ave

Aventura, FL 33180

(305) 933-4355

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN17117 Akerman, Carolina

NPI: 1205924560 LIC: DN17117

CERTIFICATIONS :

• Inhalation Sedation

# DN21763 Bula, Aurelio

NPI: 1023304391 LIC: DN21763

CERTIFICATIONS :

# DN21753 Levin, Shelly

NPI: 1023351715 LIC: DN21753

CERTIFICATIONS :

• Inhalation Sedation

#013539

Main Street Children's Dentistry

of Miami Lakes, PLLC

15501 Nw 67Th Ave Ste 201

Miami Lakes, FL 33014

(786) 577-4968

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN16341 Garcia, Oscar

NPI: 1023180171 LIC: DN16341

CERTIFICATIONS :

• Inhalation Sedation

# DN18852 Krajewski, Helena

NPI: 1356670988 LIC: DN18852

CERTIFICATIONS :

• Inhalation Sedation

#011300

Main Street Children's Dentistry

of Palmetto Bay

8805 Sw 144Th Street

Palmetto Bay, FL 33176

(305) 969-3122

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 10am - 7pm

W-Th 9am-5pm

# DN16341 Garcia, Oscar

NPI: 1023180171 LIC: DN16341

CERTIFICATIONS :

• Inhalation Sedation

# DN19570 Ortega, Fabiola

NPI: 1790002038 LIC: DN19570

CERTIFICATIONS :

• Inhalation Sedation

# DN21025 Rosenbaum, Ashley

NPI: 1053701771 LIC: DN21025

CERTIFICATIONS :

• Inhalation Sedation

# DN17342 Smitley, Michelle

NPI: 1750508628 LIC: DN17342

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

#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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#015173

Nicklaus Children's Hospital

3601 Nw 107Th Ave Ste 300

Doral, FL 33178

(786) 624-3368

Special Needs: Yes

Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN21680 Aponte-Rodriguez,

Suheily

NPI: 1396003950 LIC: DN21680

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19448 Arevalo, Oscar

NPI: 1457443285 LIC: DN19448

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19778 Freitas, Vanessa

NPI: 1255569059 LIC: DN19778

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious 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 160 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21331 Lolo, Patrick

NPI: 1609257484 LIC: DN21331

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

# DN19604 Meincken, Melissa

NPI: 1912234782 LIC: DN19604

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN24006 Miranda Bucio, Paula

NPI: 1336498625 LIC: DN24006

CERTIFICATIONS :

# DN18428 Saverin, Michele

NPI: 1134389703 LIC: DN18428

CERTIFICATIONS :

• Pediatric Conscious Sedation

#016745

Pediatric Dental Center of

Biscayne Inc

557 Ne 81St St

Miami, FL 33138

(305) 456-2680

Special Needs: Yes

M-T 8am-5pm

W-F 8am-5pm

# DN17284 Acosta, Enrique

NPI: 1790708865 LIC: DN17284

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22070 Godoy, Daniella

NPI: 1740770213 LIC: DN22070

CERTIFICATIONS :

• Inhalation Sedation

# DN20908 Mutawalli, Khalid

NPI: 1750754818 LIC: DN20908

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19595 Trujillo, Maria

NPI: 1942598404 LIC: DN19595

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#010834

Pediatric Dental Center of

Homestead

925 Ne 30Th Terrace, Ste 302

Homestead, FL 33033

(305) 246-3800

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 3pm

# DN17284 Acosta, Enrique

NPI: 1790708865 LIC: DN17284

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22070 Godoy, Daniella

NPI: 1740770213 LIC: DN22070

CERTIFICATIONS :

• Inhalation Sedation

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19595 Trujillo, Maria

NPI: 1942598404 LIC: DN19595

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#007593

Pediatric Dental Centers of Miami

2645 Douglas Rd, Ste # 703

Miami, FL 33133

(305) 448-3228

Special Needs: Yes

English, Spanish

M-T 9am-4pm

W-Th 9am-4pm

# DN17284 Acosta, Enrique

NPI: 1790708865 LIC: DN17284

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22070 Godoy, Daniella

NPI: 1740770213 LIC: DN22070

CERTIFICATIONS :

• Inhalation Sedation

# DN21002 Ovalles, Fransheska

NPI: 1497195499 LIC: DN21002

CERTIFICATIONS :

• Inhalation Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19595 Trujillo, Maria

NPI: 1942598404 LIC: DN19595

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#009435

Phanord & Associates, PA

1245 Nw 119Th St

North Miami, FL 33167

(305) 685-7863

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French

M 9am - 6pm, T 9am - 4pm

W 9am-6pm, Th 9am-4pm,F 8am-1pm

# DN14809 Jobson, Margot

NPI: 1609974039 LIC: DN14809

CERTIFICATIONS :

• Inhalation Sedation

#009996

Sabal Palm Dental Associates, P.A.

5337 Ne 2Nd Ave

Miami, FL 33137

www.phanord.com

(305) 758-0815

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), French, Haitian;

Haitian Creole

M 9am - 4pm, T 10am - 4pm

# DN14809 Jobson, Margot

NPI: 1609974039 LIC: DN14809

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#014447

Sunkidz Pediatric Dentistry

1045 Ne 125Th St

Miami, FL 33161

sunkidzdental.com

(305) 800-5439

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 161 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Spanish, Creoles and Pidgins

English-based(other)

M 8am - 4pm, T 9am - 5pm

Th-F 9am-5pm

# DN19103 Patel, Rita

NPI: 1548578776 LIC: DN19103

CERTIFICATIONS :

• Inhalation Sedation

#015932

Super Teeth Pediatric Dentistry

2260 Sw 87Th Ave

Miami, FL 33165

(305) 542-4140

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 7am - 4pm

W-Th 9am-5pm

# DN18722 Garcia-Labori, Anahi

NPI: 1922236033 LIC: DN18722

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

#010762

Dental Associates of Homestead

925 Ne 30 Terrace, Ste 114

Homestead, FL 33033

(305) 247-0910

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN17208 Berkowitz, Steven

NPI: 1982853339 LIC: DN17208

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#010673

Dental Center At Aventura

19086 Ne 29 Ave

Aventura, FL 33180

(305) 682-1554

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 8am - 5pm

W 9am-5pm, Th 8am-5pm,F 8am-3pm

# DN17208 Berkowitz, Steven

NPI: 1982853339 LIC: DN17208

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#010663

Miami Beach Center for Dental

Specialties, PA

333 Arthur Godfrey Road, Ste 818

Miami Beach, FL 33140

(305) 674-0095

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN17440 Oliver, Francisco

NPI: 1437316510 LIC: DN17440

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

# DN13591 Nielsen, Pamela

NPI: 1124118245 LIC: DN13591

CERTIFICATIONS :

#010664

Palmetto Center for Dental

Specialties

7150 W 20Th Ave, Ste 102

Hialeah, FL 33016

(305) 556-5600

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17440 Oliver, Francisco

NPI: 1437316510 LIC: DN17440

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 :

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 162 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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 :

PEDIATRIC DENTISTRY

#014429

Preventive Dentistry For Children,

9713 Overseas Hwy

Marathon, FL 33050

(305) 743-4670

Special Needs: Yes

English, Spanish, French

M-T 9am-6pm

W-F 9am-6pm

S 9am - 6pm

# DN17035 Vedrenne-Rangel, Denise

NPI: 1942401773 LIC: DN17035

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

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

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 :

#CHC10177

DOH - Okaloosa County Health

Department

810 E. James Lee Blvd

Crestview, FL 32539

www.healthyokaloosa.com

(850) 689-5593

Special Needs: No

English

M-T 7am-4pm

W-F 7am-4pm

# DN10432 Hencinski, Mary

NPI: 1669487070 LIC: DN10432

CERTIFICATIONS :

# HAD89 Millar, Leslie

NPI: 1851361901 LIC: HAD89

CERTIFICATIONS :

# DTC49 Tabert, Corinne

NPI: 1366621435 LIC: DTC49

CERTIFICATIONS :

ENDODONTICS

#018805

Seabreeze Endodontics

4579 E Hwy 20 Ste 220

Niceville, FL 32578

(850) 424-7368

Special Needs: Yes

English, Norwegian

M-T 8am-4pm

W-Th 8am-4pm

# DN17872 Hanson, Shane

NPI: 1710907787 LIC: DN17872

CERTIFICATIONS :

• Inhalation Sedation

# DN23943 Suhler, Michael

NPI: 1851351647 LIC: DN23943

CERTIFICATIONS :

ORTHODONTIST

#019096

Fishbein Orthodontics

2100 S. Ferdon Blvd Ste 150

Crestview, FL 32536

(850) 477-1089

Special Needs: Yes

English

M 8am - 5pm,

W 8am-5pm,

# DN22677 De Moya, Adrian

NPI: 1790259372 LIC: DN22677

CERTIFICATIONS :

# DN18812 Fishbein, Benjamin

NPI: 1144543620 LIC: DN18812

CERTIFICATIONS :

# DN22495 Howle, Sarah

NPI: 1215477146 LIC: DN22495

CERTIFICATIONS :

# DN18855 Rezaie, Maryam

NPI: 1467781443 LIC: DN18855

CERTIFICATIONS :

#020416

Fishbein Orthodontics

403 Hollywood Blvd Sw, Ste A-102

Fort Walton Beach, FL 32548

(850) 477-1089

Special Needs: Yes

English

M 8am - 5pm,

# DN22677 De Moya, Adrian

NPI: 1790259372 LIC: DN22677

CERTIFICATIONS :

# DN18812 Fishbein, Benjamin

NPI: 1144543620 LIC: DN18812

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 163 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN22495 Howle, Sarah

NPI: 1215477146 LIC: DN22495

CERTIFICATIONS :

# DN18855 Rezaie, Maryam

NPI: 1467781443 LIC: DN18855

CERTIFICATIONS :

#018805

Seabreeze Endodontics

4579 E Hwy 20 Ste 220

Niceville, FL 32578

(850) 424-7368

Special Needs: Yes

English, Norwegian

M-T 8am-4pm

W-Th 8am-4pm

# DN22677 De Moya, Adrian

NPI: 1790259372 LIC: DN22677

CERTIFICATIONS :

# DN18855 Rezaie, Maryam

NPI: 1467781443 LIC: DN18855

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#019213

Panhandle Pediatric Dentistry,

PLLC

4506 East Hwy 20 Ste 100

Niceville, FL 32578

(850) 308-1733

Special Needs: Yes

English

M-T 8am-4pm

W-Th 8am-4pm

# DN16280 Berry, Stephen Eric

NPI: 1699889352 LIC: DN16280

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN23156 Fujawa, Douglas

NPI: 1336541135 LIC: DN23156

CERTIFICATIONS :

• Inhalation Sedation

# DN24675 Harrell, Robbie

NPI: 1780113944 LIC: DN24675

CERTIFICATIONS :

# DN23264 Johnson, Patrick

NPI: 1770932402 LIC: DN23264

CERTIFICATIONS :

• Inhalation Sedation

# DN20298 Lapointe, Lisa

NPI: 1336454701 LIC: DN20298

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

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 :

#007660

Amani Alkhairi, DMD., P.A.

1009 Amber Road

Orlando, FL 32807

www.amberdentalcare.com

(407) 282-0134

Special Needs: Yes

English, Arabic, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN16122 Alkhairi, Amani

NPI: 1669743092 LIC: DN16122

CERTIFICATIONS :

#012040

Americana Family Dental Center

2067 Americana Blvd

Orlando, FL 32839

(407) 850-0133

Special Needs: No

English, Arabic, Creoles and Pidgins

English-based(other), French, Spanish

M-T 8am-4pm

W 8am-5pm, Th 8am-4pm,F 8am-1pm

# DN20527 Sadek, Wael

NPI: 1083031850 LIC: DN20527

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

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 164 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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 :

#009979

Arbor Dentistry, LLC

1112 North Rock Springs Road

Apopka, FL 32712

(407) 814-3969

Special Needs: Yes

Vietnamese, English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15508 Trinh, Philip

NPI: 1356453930 LIC: DN15508

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 :

#010484

Avalon Dental Group

1610 Rouse Rd

Orlando, FL 32825

(407) 281-1119

Special Needs: Yes

Spanish, English, Vietnamese

T 9am - 5pm

W-F 9am-5pm

S 9am - 3pm

# DN17997 Van, Jennie

NPI: 1831399344 LIC: DN17997

CERTIFICATIONS :

# DN17986 Van, Nga

NPI: 1023217163 LIC: DN17986

CERTIFICATIONS :

#011658

Bright Smile Dental

8010 Sunport Dr Ste 115

Orlando, FL 32809

www.brightsmileoforlando.com

(407) 412-7887

Special Needs: Yes

English, Spanish, Tagalog, Thai

M-T 9am-5pm

W-Th 9am-5pm

S 9am - 5pm

# DN19953 Jain, Anju

NPI: 1952654576 LIC: DN19953

CERTIFICATIONS :

# DN17990 Jaraplasan, Romy

NPI: 1770762882 LIC: DN17990

CERTIFICATIONS :

# DN17989 Thanasasavat, Sirin

NPI: 1437347101 LIC: DN17989

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

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 :

#019827

Charles Arias DDS

508 N Mills Ave Ste A

Orlando, FL 32803

(407) 856-5777

Special Needs: Yes

English, Spanish

M 9am - 3pm, T 10am - 5pm

W 9am-3pm, Th 10am-5pm,F

9am-12pm

S 9am - 3pm

# DN9145 Arias, Charles

NPI: 1548382377 LIC: DN9145

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

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 165 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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 :

#007648

Cosmetic & Family Dentistry LLC

6900 Turkey Lake Road, Ste 1-9

Orlando, FL 32819

(407) 352-7700

Special Needs: Yes

English, Spanish, Hindi

M-T 8am-5pm

W 9am-5pm, Th 8am-5pm

# DN14640 Oberoi, Ravi

NPI: 1023143229 LIC: DN14640

CERTIFICATIONS :

#022165

Creative Dental LLC

10231 E. Colonial Drive

Orlando, FL 32817

(407) 985-2885

Special Needs: No

Arabic, English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN18292 Al Shareef, Amer

NPI: 1790943405 LIC: DN18292

CERTIFICATIONS :

# DN23320 Chaballout, Tasneem

NPI: 1558717223 LIC: DN23320

CERTIFICATIONS :

# DN17585 Mousa, Ammar

NPI: 1962413781 LIC: DN17585

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 :

#012817

Dr. Linda Soper-Maier

410 E Main St

Apopka, FL 32703

(407) 889-2232

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN13178 Soper-Maier, Linda

NPI: 1457532384 LIC: DN13178

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

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

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 166 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#012442

Evelyn Miranda Halem, DMD, PA

1405 S Hiawassee Rd Ste C

Orlando, FL 32835

(407) 294-6009

Special Needs: No

Spanish, English

T 9am - 5pm

W-Th 9am-5pm

# DN13516 Halem, Evelyn

NPI: 1881901999 LIC: DN13516

CERTIFICATIONS :

#018699

Exclusive Dentistry

7326 Lake Underhill Rd

Orlando, FL 32822

(407) 704-2094

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN21904 Leon, Vanessa

NPI: 1245682210 LIC: DN21904

CERTIFICATIONS :

# DN18459 Quintero, Jorge

NPI: 1235386020 LIC: DN18459

CERTIFICATIONS :

• Inhalation Sedation

#016390

Family Dental

10691 E Colonial Dr

Orlando, FL 32817

http://www.brightsmileoforlando.com

(407) 482-8072

Special Needs: No

Spanish, Tagalog, Thai

M 9am - 3pm,

W 9am-3pm,

# DN17990 Jaraplasan, Romy

NPI: 1770762882 LIC: DN17990

CERTIFICATIONS :

#007691

Four Season Dental

4501 South Semoran Blvd, Ste C

Orlando, FL 32822

www.stardentalimplants.com

(407) 381-3377

Special Needs: No

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

# DN16791 Morales, Herman

NPI: 1497745491 LIC: DN16791

CERTIFICATIONS :

#015112

Greenberg Dental - Apopka

2216 E. Semoran Blvd

Apopka, FL 32703

(407) 889-4360

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M 7am - 7pm, T 7am - 6pm

Th-F 7am-3pm

S 8am - 1pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

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 167 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015120

Greenberg Dental - Conway

4442 Curry Ford Rd Ste A

Orlando, FL 32812

(407) 482-5855

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 7am-3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

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 168 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015119

Greenberg Dental - East Colonial

4307 E. Colonial Dr

Orlando, FL 32803

(407) 514-0400

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 1pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle*

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

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 169 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

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 170 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015132

Greenberg Dental - FL Mall

8204 Crystal Clear Ln, Ste 600

Orlando, FL 32809

(407) 239-0126

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-3pm

W-Th 10am-6pm

S 8am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

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 171 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015129

Greenberg Dental - Highland

7319 W. Colonial Dr

Orlando, FL 32818

(407) 294-9200

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 7am-6pm

W-Th 7am-6pm

S 8am - 1pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

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 172 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015121

Greenberg Dental - Kirkman

4732 S. Kirkman Rd

Orlando, FL 32811

(407) 292-7373

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

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 173 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015111

Greenberg Dental - Lee Road

2200 Lee Rd

Winter Park, FL 32789

(407) 628-9877

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

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 174 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

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 175 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#007473

Greenberg Dental - Rosemont

5824 N. Orange Blossom Trail

Orlando, FL 32810

(407) 979-4881

Special Needs: Yes

Spanish, Creoles and Pidgins

English-based(other)

M-T 10am-6pm

W-Th 8am-4pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

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 176 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015124

Greenberg Dental - Williamsburg

5316 Central Florida Pkwy

Orlando, FL 32821

(407) 239-9557

Special Needs: Yes

English, Spanish, Tagalog, Vietnamese

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

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 177 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015104

Greenberg Dental - Winter Garden

13361 W. Colonial Dr.

Winter Garden, FL 34787

(407) 905-9622

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

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 178 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015116

Greenberg Dental - Winter Park

3727 N. Goldenrod Rd, Ste 108

Winter Park, FL 32792

(407) 671-0001

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-7pm

W-Th 7am-6pm

S 8am - 2pm

# DN11922 Amaro, David*

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven*

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle*

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben*

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha*

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana*

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny*

NPI: 1376502104 LIC: DN14554

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 179 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# 059393 Dirawi, Sam*

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh*

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy*

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole*

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel*

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine*

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie*

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez*

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael*

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover*

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert*

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza*

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison*

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset*

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew*

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin*

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit*

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward*

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska*

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura*

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz*

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy*

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung*

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang*

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda*

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz*

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick*

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar*

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha*

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri*

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka*

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal*

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky*

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha*

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen*

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine*

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris*

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick*

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos*

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta*

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya*

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye*

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy*

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica*

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat*

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie*

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron*

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael*

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief*

NPI: 1932620952 LIC: DN22631

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 180 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN21835 Yu, Lina*

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#014120

Greenberg Dental & Orthodontics

5425 S. Semoran Blvd., Ste 5A

Orlando, FL 32822

(407) 545-4451

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 2pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

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 181 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015531

Greenberg Dental & Orthodontics

13188 E. Colonial Drive, Ste B5

Orlando, FL 32826

(407) 930-4035

Special Needs: Yes

English, Spanish, Mandarin Chinese

M-T 7am-3pm

W-Th 10am-6pm

S 7am - 2pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

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 182 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#020829

Greenberg Dental & Orthodontics

2845 S. Orange Ave, Ste 180

Orlando, FL 32806

(407) 734-1882

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 4pm

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23434 Chohan, Sumera

NPI: 1922592609 LIC: DN23434

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN22704 Foreman, Kathleen

NPI: 1407377724 LIC: DN22704

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN22428 Salehi, Shiva

NPI: 1346696549 LIC: DN22428

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

#007989

Hans R. Koenig, DMD PA

500 N. Semoran Blvd Ste 102

Orlando, FL 32807

www.hanskoenigdmd.com

(407) 277-6272

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN18472 Koenig, Hans

NPI: 1760535934 LIC: DN18472

CERTIFICATIONS :

• Inhalation Sedation

# DN22645 Qadri, Sameera

NPI: 1790957934 LIC: DN22645

CERTIFICATIONS :

• Inhalation Sedation

#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

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 183 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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 :

#012352

LG Dental Group PA

12927 S Orange Blossom Trl

Orlando, FL 32837

(407) 240-4900

Special Needs: Yes

Spanish, English

M-T 8am-5pm

W-Th 8am-5pm

# DN14158 Guerra, Luz

NPI: 1730178310 LIC: DN14158

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 :

#015894

Mariam M Habib, DDS

801 Paul Street

Orlando, FL 32808

(407) 290-0367

Special Needs: Yes

English, Arabic, Spanish

M-T 8am-5pm

W-F 8am-5pm

# 22DI02701800 Habib, Mariam

NPI: 1851706485 LIC: 22DI02701800

CERTIFICATIONS :

#FQHC015413

Meadow Woods Dental

(Community Health Center)

849 Greenway Professional Court

Orlando, FL 32824

(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 :

#012926

Oakridge Plaza Dental, Inc

4029 W. Oakridge Rd

Orlando, FL 32809

(407) 363-1777

Special Needs: No

Spanish

M-T 10am-5pm

W-Th 10am-5pm

# DN12966 Sheth, Purnima

NPI: 1477656478 LIC: DN12966

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 :

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 184 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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

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 :

#011945

Pediatric & Family Dental Group,

LLC

6161 Winegard Rd

Orlando, FL 32809

(407) 749-0113

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN20808 Azer, Hany

NPI: 1295152312 LIC: DN20808

CERTIFICATIONS :

# DN19029 Jones, Latoya

NPI: 1184944753 LIC: DN19029

CERTIFICATIONS :

• Inhalation Sedation

# DN19618 Nikfar, Rosana

NPI: 1225352974 LIC: DN19618

CERTIFICATIONS :

• Inhalation Sedation

#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 :

#010975

Silver Star Dental Center, Inc.

5028 Silver Star Road

Orlando, FL 32808

(407) 291-1997

Special Needs: No

English, Arabic, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN13724 Nakhla, Wafiek

NPI: 1417025792 LIC: DN13724

CERTIFICATIONS :

#011275

Thornton Dental Centre

630 North Thornton Ave

Orlando, FL 32803

(407) 648-0000

Special Needs: Yes

English, Vietnamese

M-T 8am-4pm

W 8am-4pm,

# DN15012 Duong, Thai

NPI: 1306916820 LIC: DN15012

CERTIFICATIONS :

#013190

Willie B. Sherman, Jr., DDS, PA

3599 Columbia St

Orlando, FL 32805

(407) 295-0674

Special Needs: Yes

English

T 9am - 5pm

# DN6455 Sherman, Willie

NPI: 1982956447 LIC: DN6455

CERTIFICATIONS :

#011428

Yasmin R. Ahmed, BDS, DDS, PA

647 W South St

Orlando, FL 32805

(407) 843-7426

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 185 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Arabic, Bengali, Gujarati,

Hindi, Punjabi, Urdu

M-T 10am-3pm

W-Th 10am-3pm

# DN13932 Ahmed, Yasmin

NPI: 1497765796 LIC: DN13932

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

ENDODONTICS

#015112

Greenberg Dental - Apopka

2216 E. Semoran Blvd

Apopka, FL 32703

(407) 889-4360

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M 7am - 7pm, T 7am - 6pm

Th-F 7am-3pm

S 8am - 1pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015120

Greenberg Dental - Conway

4442 Curry Ford Rd Ste A

Orlando, FL 32812

(407) 482-5855

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 7am-3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015119

Greenberg Dental - East Colonial

4307 E. Colonial Dr

Orlando, FL 32803

(407) 514-0400

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 1pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015132

Greenberg Dental - FL Mall

8204 Crystal Clear Ln, Ste 600

Orlando, FL 32809

(407) 239-0126

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-3pm

W-Th 10am-6pm

S 8am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

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 186 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015129

Greenberg Dental - Highland

7319 W. Colonial Dr

Orlando, FL 32818

(407) 294-9200

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 7am-6pm

W-Th 7am-6pm

S 8am - 1pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015121

Greenberg Dental - Kirkman

4732 S. Kirkman Rd

Orlando, FL 32811

(407) 292-7373

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015111

Greenberg Dental - Lee Road

2200 Lee Rd

Winter Park, FL 32789

(407) 628-9877

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015113

Greenberg Dental - Maitland

2301 Maitland Center Pkwy, Ste 128

Maitland, FL 32751

(407) 660-8080

Special Needs: Yes

Spanish

M 7am - 6pm, T 7am - 3pm

W 10am-6pm, Th 7am-6pm,F

7am-3pm

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

#007473

Greenberg Dental - Rosemont

5824 N. Orange Blossom Trail

Orlando, FL 32810

(407) 979-4881

Special Needs: Yes

Spanish, Creoles and Pidgins

English-based(other)

M-T 10am-6pm

W-Th 8am-4pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

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 187 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015124

Greenberg Dental - Williamsburg

5316 Central Florida Pkwy

Orlando, FL 32821

(407) 239-9557

Special Needs: Yes

English, Spanish, Tagalog, Vietnamese

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015104

Greenberg Dental - Winter Garden

13361 W. Colonial Dr.

Winter Garden, FL 34787

(407) 905-9622

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015116

Greenberg Dental - Winter Park

3727 N. Goldenrod Rd, Ste 108

Winter Park, FL 32792

(407) 671-0001

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-7pm

W-Th 7am-6pm

S 8am - 2pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley*

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew*

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James*

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan*

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera*

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#014120

Greenberg Dental & Orthodontics

5425 S. Semoran Blvd., Ste 5A

Orlando, FL 32822

(407) 545-4451

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 2pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015531

Greenberg Dental & Orthodontics

13188 E. Colonial Drive, Ste B5

Orlando, FL 32826

(407) 930-4035

Special Needs: Yes

English, Spanish, Mandarin Chinese

M-T 7am-3pm

W-Th 10am-6pm

S 7am - 2pm

# DN19321 Bienias, Russell*

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 188 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#020829

Greenberg Dental & Orthodontics

2845 S. Orange Ave, Ste 180

Orlando, FL 32806

(407) 734-1882

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 4pm

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#019998

Orlando Endodontic Specialist

-East

12301 Lake Underhill Rd Ste 104

Orlando, FL 32828

(407) 581-9515

Special Needs: No

English, Spanish, Creoles and Pidgins

English-based(other), Vietnamese

M 8am - 4pm, T 8am - 5pm

W-F 8am-5pm

# DN16516 Aippersbach, William*

NPI: 1245368711 LIC: DN16516

CERTIFICATIONS :

# DN16558 Isler, Aaron*

NPI: 1174627343 LIC: DN16558

CERTIFICATIONS :

# DN14871 Jungermann, Gretchen*

NPI: 1285693259 LIC: DN14871

CERTIFICATIONS :

# DN14322 Kharazi, Mehrbod*

NPI: 1902820509 LIC: DN14322

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

#021700

Volusia Endodontics Maitland PA

670 N Orlando Ave, Ste 203

Maitland, FL 32751

midfloridarootcanals.com

(407) 755-4700

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other), Portuguese

M-T 8am-5pm

W-F 8am-5pm

# DN16516 Aippersbach, William

NPI: 1245368711 LIC: DN16516

CERTIFICATIONS :

# DN16558 Isler, Aaron

NPI: 1174627343 LIC: DN16558

CERTIFICATIONS :

# DN14871 Jungermann, Gretchen

NPI: 1285693259 LIC: DN14871

CERTIFICATIONS :

# DN14322 Kharazi, Mehrbod*

NPI: 1902820509 LIC: DN14322

CERTIFICATIONS :

# DN16984 Lipkin, Brad

NPI: 1619060217 LIC: DN16984

CERTIFICATIONS :

# DN19593 Mir, Hamza

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

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

#015112

Greenberg Dental - Apopka

2216 E. Semoran Blvd

Apopka, FL 32703

(407) 889-4360

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M 7am - 7pm, T 7am - 6pm

Th-F 7am-3pm

S 8am - 1pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015120

Greenberg Dental - Conway

4442 Curry Ford Rd Ste A

Orlando, FL 32812

(407) 482-5855

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 7am-3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• 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 189 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015119

Greenberg Dental - East Colonial

4307 E. Colonial Dr

Orlando, FL 32803

(407) 514-0400

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 1pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015132

Greenberg Dental - FL Mall

8204 Crystal Clear Ln, Ste 600

Orlando, FL 32809

(407) 239-0126

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-3pm

W-Th 10am-6pm

S 8am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015129

Greenberg Dental - Highland

7319 W. Colonial Dr

Orlando, FL 32818

(407) 294-9200

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 7am-6pm

W-Th 7am-6pm

S 8am - 1pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015121

Greenberg Dental - Kirkman

4732 S. Kirkman Rd

Orlando, FL 32811

(407) 292-7373

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015111

Greenberg Dental - Lee Road

2200 Lee Rd

Winter Park, FL 32789

(407) 628-9877

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#007473

Greenberg Dental - Rosemont

5824 N. Orange Blossom Trail

Orlando, FL 32810

(407) 979-4881

Special Needs: Yes

Spanish, Creoles and Pidgins

English-based(other)

M-T 10am-6pm

W-Th 8am-4pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

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 190 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015124

Greenberg Dental - Williamsburg

5316 Central Florida Pkwy

Orlando, FL 32821

(407) 239-9557

Special Needs: Yes

English, Spanish, Tagalog, Vietnamese

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015104

Greenberg Dental - Winter Garden

13361 W. Colonial Dr.

Winter Garden, FL 34787

(407) 905-9622

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015116

Greenberg Dental - Winter Park

3727 N. Goldenrod Rd, Ste 108

Winter Park, FL 32792

(407) 671-0001

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-7pm

W-Th 7am-6pm

S 8am - 2pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#014120

Greenberg Dental & Orthodontics

5425 S. Semoran Blvd., Ste 5A

Orlando, FL 32822

(407) 545-4451

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 2pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015531

Greenberg Dental & Orthodontics

13188 E. Colonial Drive, Ste B5

Orlando, FL 32826

(407) 930-4035

Special Needs: Yes

English, Spanish, Mandarin Chinese

M-T 7am-3pm

W-Th 10am-6pm

S 7am - 2pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#020754

Oral Facial Surgical Arts PA

10437 Moss Park Road, Ste C

Orlando, FL 32832

(407) 207-8005

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN16913 Achong, Ronald

NPI: 1568485282 LIC: DN16913

CERTIFICATIONS :

# DN18401 Latham, Christopher

NPI: 1831353747 LIC: DN18401

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 191 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

ORTHODONTIST

#021362

Baptiste Orthodontics

7260 W Colonial Drive

Orlando, FL 32818

www.baptisteorthodontics.com

(407) 294-1560

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN15927 Baptiste, Andre

NPI: 1194841825 LIC: DN15927

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#021363

Baptiste Orthodontics

12 South Park Ave

Apopka, FL 32703

(407) 801-7775

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15927 Baptiste, Andre

NPI: 1194841825 LIC: DN15927

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#021371

Baptiste Orthodontics

8907 Conroy Windermere Road Ste

E2 & E3

Orlando, FL 32835

(407) 217-2927

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15927 Baptiste, Andre

NPI: 1194841825 LIC: DN15927

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#011442

Carlyle Orthodontics

8255 Lee Vista Blvd, Ste D

Orlando, FL 32829

(407) 447-9060

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN16534 Carlyle-Clark, Kimberly

NPI: 1831178540 LIC: DN16534

CERTIFICATIONS :

#015112

Greenberg Dental - Apopka

2216 E. Semoran Blvd

Apopka, FL 32703

(407) 889-4360

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M 7am - 7pm, T 7am - 6pm

Th-F 7am-3pm

S 8am - 1pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015120

Greenberg Dental - Conway

4442 Curry Ford Rd Ste A

Orlando, FL 32812

(407) 482-5855

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 7am-3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015119

Greenberg Dental - East Colonial

4307 E. Colonial Dr

Orlando, FL 32803

(407) 514-0400

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 1pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

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 192 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

#015132

Greenberg Dental - FL Mall

8204 Crystal Clear Ln, Ste 600

Orlando, FL 32809

(407) 239-0126

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-3pm

W-Th 10am-6pm

S 8am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015129

Greenberg Dental - Highland

7319 W. Colonial Dr

Orlando, FL 32818

(407) 294-9200

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 7am-6pm

W-Th 7am-6pm

S 8am - 1pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015121

Greenberg Dental - Kirkman

4732 S. Kirkman Rd

Orlando, FL 32811

(407) 292-7373

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015111

Greenberg Dental - Lee Road

2200 Lee Rd

Winter Park, FL 32789

(407) 628-9877

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#007473

Greenberg Dental - Rosemont

5824 N. Orange Blossom Trail

Orlando, FL 32810

(407) 979-4881

Special Needs: Yes

Spanish, Creoles and Pidgins

English-based(other)

M-T 10am-6pm

W-Th 8am-4pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

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 193 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015124

Greenberg Dental - Williamsburg

5316 Central Florida Pkwy

Orlando, FL 32821

(407) 239-9557

Special Needs: Yes

English, Spanish, Tagalog, Vietnamese

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015104

Greenberg Dental - Winter Garden

13361 W. Colonial Dr.

Winter Garden, FL 34787

(407) 905-9622

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015116

Greenberg Dental - Winter Park

3727 N. Goldenrod Rd, Ste 108

Winter Park, FL 32792

(407) 671-0001

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-7pm

W-Th 7am-6pm

S 8am - 2pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#014120

Greenberg Dental & Orthodontics

5425 S. Semoran Blvd., Ste 5A

Orlando, FL 32822

(407) 545-4451

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 2pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

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 194 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1316433865 LIC: DN23530

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

# DN13320 Carr, Elaine

NPI: 1093141319 LIC: DN13320

CERTIFICATIONS :

#016726

Orlando Orthodontics Corp

1525 W. Colonial Dr

Orlando, FL 32804

(407) 990-3111

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 5pm,

S 8am - 5pm

# DN18332 Nguyen, James

NPI: 1174783278 LIC: DN18332

CERTIFICATIONS :

#011492

Orthodontics of Central FL

14055 S. Town Loop Blvd, Ste 100

Orlando, FL 32837

(407) 826-0111

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN13313 DeJesus, Maritza

NPI: 1669521209 LIC: DN13313

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#015112

Greenberg Dental - Apopka

2216 E. Semoran Blvd

Apopka, FL 32703

(407) 889-4360

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M 7am - 7pm, T 7am - 6pm

Th-F 7am-3pm

S 8am - 1pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015120

Greenberg Dental - Conway

4442 Curry Ford Rd Ste A

Orlando, FL 32812

(407) 482-5855

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 7am-3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015119

Greenberg Dental - East Colonial

4307 E. Colonial Dr

Orlando, FL 32803

(407) 514-0400

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 1pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015132

Greenberg Dental - FL Mall

8204 Crystal Clear Ln, Ste 600

Orlando, FL 32809

(407) 239-0126

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-3pm

W-Th 10am-6pm

S 8am - 3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• 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 195 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015129

Greenberg Dental - Highland

7319 W. Colonial Dr

Orlando, FL 32818

(407) 294-9200

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 7am-6pm

W-Th 7am-6pm

S 8am - 1pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015121

Greenberg Dental - Kirkman

4732 S. Kirkman Rd

Orlando, FL 32811

(407) 292-7373

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015111

Greenberg Dental - Lee Road

2200 Lee Rd

Winter Park, FL 32789

(407) 628-9877

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#007473

Greenberg Dental - Rosemont

5824 N. Orange Blossom Trail

Orlando, FL 32810

(407) 979-4881

Special Needs: Yes

Spanish, Creoles and Pidgins

English-based(other)

M-T 10am-6pm

W-Th 8am-4pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

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 196 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015124

Greenberg Dental - Williamsburg

5316 Central Florida Pkwy

Orlando, FL 32821

(407) 239-9557

Special Needs: Yes

English, Spanish, Tagalog, Vietnamese

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015104

Greenberg Dental - Winter Garden

13361 W. Colonial Dr.

Winter Garden, FL 34787

(407) 905-9622

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015116

Greenberg Dental - Winter Park

3727 N. Goldenrod Rd, Ste 108

Winter Park, FL 32792

(407) 671-0001

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-7pm

W-Th 7am-6pm

S 8am - 2pm

# DN18391 Harrell, Laurie*

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka*

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent*

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent*

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#014120

Greenberg Dental & Orthodontics

5425 S. Semoran Blvd., Ste 5A

Orlando, FL 32822

(407) 545-4451

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 2pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• 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 197 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Pediatric Conscious Sedation

#015531

Greenberg Dental & Orthodontics

13188 E. Colonial Drive, Ste B5

Orlando, FL 32826

(407) 930-4035

Special Needs: Yes

English, Spanish, Mandarin Chinese

M-T 7am-3pm

W-Th 10am-6pm

S 7am - 2pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#020829

Greenberg Dental & Orthodontics

2845 S. Orange Ave, Ste 180

Orlando, FL 32806

(407) 734-1882

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 4pm

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

#020449

HI 5 Children's Dentistry

8255 Lee Vista Blvd F-G

Orlando, FL 32829

(407) 810-0450

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN17078 Aliotti, Michelle*

NPI: 1124142062 LIC: DN17078

CERTIFICATIONS :

# DN21458 Bracho-Pacheco,

Andreina

NPI: 1073940730 LIC: DN21458

CERTIFICATIONS :

• Inhalation Sedation

# DN19471 Tabares, Miguel

NPI: 1194003210 LIC: DN19471

CERTIFICATIONS :

• Inhalation Sedation

#011292

Main Street Children's Dentistry

& Ortho

501 N. Orlando Ave Ste 233

Winter Park, FL 32789

(407) 622-1000

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19134 Aloise, Domenic*

NPI: 1124312830 LIC: DN19134

CERTIFICATIONS :

• Inhalation Sedation

# DN23909 Iral-Pineda, Juliana*

NPI: 1114333143 LIC: DN23909

CERTIFICATIONS :

# DTP526 Noguera, Alberto*

NPI: 1619206752 LIC: DTP526

CERTIFICATIONS :

• Inhalation Sedation

# DN20024 Roberti, Sabrina*

NPI: 1841632924 LIC: DN20024

CERTIFICATIONS :

# DN20826 Tejada, Rodolfo*

NPI: 1427345057 LIC: DN20826

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#020356

Main Street Children's Dentistry

and Orthodontics Waterford

12150 Lake Underhill Rd

Orlando, FL 32825

(321) 319-7027

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DTP526 Noguera, Alberto

NPI: 1619206752 LIC: DTP526

CERTIFICATIONS :

• Inhalation Sedation

#011945

Pediatric & Family Dental Group,

LLC

6161 Winegard Rd

Orlando, FL 32809

(407) 749-0113

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN17111 Aina, Olubisi

NPI: 1427255694 LIC: DN17111

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN18209 Hernandez, Linnette

NPI: 1043409733 LIC: DN18209

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN21614 Mendez-Peralta, Patricia

NPI: 1558731653 LIC: DN21614

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN23920 Rodriguez-Aguiar, Glenda

NPI: 1093154460 LIC: DN23920

CERTIFICATIONS :

PERIODONTICS

#015112

Greenberg Dental - Apopka

2216 E. Semoran Blvd

Apopka, FL 32703

(407) 889-4360

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M 7am - 7pm, T 7am - 6pm

Th-F 7am-3pm

S 8am - 1pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015120

Greenberg Dental - Conway

4442 Curry Ford Rd Ste A

Orlando, FL 32812

(407) 482-5855

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 7am-3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

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 198 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

#015119

Greenberg Dental - East Colonial

4307 E. Colonial Dr

Orlando, FL 32803

(407) 514-0400

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 1pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015132

Greenberg Dental - FL Mall

8204 Crystal Clear Ln, Ste 600

Orlando, FL 32809

(407) 239-0126

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-3pm

W-Th 10am-6pm

S 8am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015129

Greenberg Dental - Highland

7319 W. Colonial Dr

Orlando, FL 32818

(407) 294-9200

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 7am-6pm

W-Th 7am-6pm

S 8am - 1pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015121

Greenberg Dental - Kirkman

4732 S. Kirkman Rd

Orlando, FL 32811

(407) 292-7373

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015111

Greenberg Dental - Lee Road

2200 Lee Rd

Winter Park, FL 32789

(407) 628-9877

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#007473

Greenberg Dental - Rosemont

5824 N. Orange Blossom Trail

Orlando, FL 32810

(407) 979-4881

Special Needs: Yes

Spanish, Creoles and Pidgins

English-based(other)

M-T 10am-6pm

W-Th 8am-4pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

#015124

Greenberg Dental - Williamsburg

5316 Central Florida Pkwy

Orlando, FL 32821

(407) 239-9557

Special Needs: Yes

English, Spanish, Tagalog, Vietnamese

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015104

Greenberg Dental - Winter Garden

13361 W. Colonial Dr.

Winter Garden, FL 34787

(407) 905-9622

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015116

Greenberg Dental - Winter Park

3727 N. Goldenrod Rd, Ste 108

Winter Park, FL 32792

(407) 671-0001

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-7pm

W-Th 7am-6pm

S 8am - 2pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#014120

Greenberg Dental & Orthodontics

5425 S. Semoran Blvd., Ste 5A

Orlando, FL 32822

(407) 545-4451

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 2pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015531

Greenberg Dental & Orthodontics

13188 E. Colonial Drive, Ste B5

Orlando, FL 32826

(407) 930-4035

Special Needs: Yes

English, Spanish, Mandarin Chinese

M-T 7am-3pm

W-Th 10am-6pm

S 7am - 2pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

PROSTHODONTICS

#015112

Greenberg Dental - Apopka

2216 E. Semoran Blvd

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 199 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Apopka, FL 32703

(407) 889-4360

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Vietnamese

M 7am - 7pm, T 7am - 6pm

Th-F 7am-3pm

S 8am - 1pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015120

Greenberg Dental - Conway

4442 Curry Ford Rd Ste A

Orlando, FL 32812

(407) 482-5855

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 7am-3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015119

Greenberg Dental - East Colonial

4307 E. Colonial Dr

Orlando, FL 32803

(407) 514-0400

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 1pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015132

Greenberg Dental - FL Mall

8204 Crystal Clear Ln, Ste 600

Orlando, FL 32809

(407) 239-0126

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-3pm

W-Th 10am-6pm

S 8am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015129

Greenberg Dental - Highland

7319 W. Colonial Dr

Orlando, FL 32818

(407) 294-9200

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 7am-6pm

W-Th 7am-6pm

S 8am - 1pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015121

Greenberg Dental - Kirkman

4732 S. Kirkman Rd

Orlando, FL 32811

(407) 292-7373

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015111

Greenberg Dental - Lee Road

2200 Lee Rd

Winter Park, FL 32789

(407) 628-9877

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 9am - 5pm

W-F 7am-3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#007473

Greenberg Dental - Rosemont

5824 N. Orange Blossom Trail

Orlando, FL 32810

(407) 979-4881

Special Needs: Yes

Spanish, Creoles and Pidgins

English-based(other)

M-T 10am-6pm

W-Th 8am-4pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015124

Greenberg Dental - Williamsburg

5316 Central Florida Pkwy

Orlando, FL 32821

(407) 239-9557

Special Needs: Yes

English, Spanish, Tagalog, Vietnamese

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015104

Greenberg Dental - Winter Garden

13361 W. Colonial Dr.

Winter Garden, FL 34787

(407) 905-9622

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015116

Greenberg Dental - Winter Park

3727 N. Goldenrod Rd, Ste 108

Winter Park, FL 32792

(407) 671-0001

Special Needs: Yes

English, Arabic, Spanish

M-T 7am-7pm

W-Th 7am-6pm

S 8am - 2pm

# DN21786 Galindo-Ramirez,

Ricardo*

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#014120

Greenberg Dental & Orthodontics

5425 S. Semoran Blvd., Ste 5A

Orlando, FL 32822

(407) 545-4451

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

S 8am - 2pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015531

Greenberg Dental & Orthodontics

13188 E. Colonial Drive, Ste B5

Orlando, FL 32826

(407) 930-4035

Special Needs: Yes

English, Spanish, Mandarin Chinese

M-T 7am-3pm

W-Th 10am-6pm

S 7am - 2pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

OSCEOLA COUNTY

DENTIST

#012839

Angel's Touch Dental Office

715 E. Vine St Ste 3

Kissimmee, FL 34744

(407) 910-4749

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 200 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Spanish

M-T 9am-5pm

Th-F 9am-5pm

S 9am - 1pm

# DN17820 Montero, Francisca

NPI: 1598849853 LIC: DN17820

CERTIFICATIONS :

#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 :

#007917

Dr. Mohamed M. Zaman, D.D.S.

PLLC

11 W. Dakin Ave

Kissimmee, FL 34741

(407) 846-3662

Special Needs: Yes

Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN12644 Zaman, Mohamed

NPI: 1710065636 LIC: DN12644

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

CERTIFICATIONS :

# DN20125 Puerto, Sandra

NPI: 1972941961 LIC: DN20125

CERTIFICATIONS :

# DN21642 Romero- Quevedo,

Margarita

NPI: 1861866782 LIC: DN21642

CERTIFICATIONS :

#015105

Greenberg Dental - Kissimmee

1379 E. Vine St

Kissimmee, FL 34744

(407) 933-8686

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

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 201 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015115

Greenberg Dental - South

Kissimmee

3233 S. John Young Pkwy

Kissimmee, FL 34746

(407) 933-1226

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

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 202 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#014760

Greenberg Dental & Orthodontics

1050 Buenaventura Blvd

Kissimmee, FL 34743

(407) 392-1780

Special Needs: Yes

English, Spanish, Portuguese, Sign

Languages

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 203 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W-Th 8am-6pm

S 8am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

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 204 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015330

Greenberg Dental & Orthodontics

5043 W. Irlo Bronson Memorial Hwy

Kissimmee, FL 34746

(407) 347-4865

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 8am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

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 205 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015118

Greenberg Dental & Orthodontics

- St. Cloud

4039 13Th St

Saint Cloud, FL 34769

(407) 892-1643

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

S 7am - 2pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

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 206 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

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 :

#021650

Happy Friendly Smiles

1319 E. Osceola Parkway, Ste C

Kissimmee, FL 34744

(407) 343-0509

Special Needs: Yes

English, Spanish

T 8am - 5pm

W-Th 8am-5pm

# DN22166 De Jesus, Joseph

NPI: 1376996652 LIC: DN22166

CERTIFICATIONS :

• Inhalation Sedation

# DN20867 Diaz Suarez, Natalia

NPI: 1437574761 LIC: DN20867

CERTIFICATIONS :

# DN12237 Figaro, Mark

NPI: 1952516965 LIC: DN12237

CERTIFICATIONS :

# DN10077 Jones, Diane

NPI: 1699893651 LIC: DN10077

CERTIFICATIONS :

# DN13831 Mathis, Roderick

NPI: 1396882833 LIC: DN13831

CERTIFICATIONS :

# DN23652 Ospina, Luz

NPI: 1881181501 LIC: DN23652

CERTIFICATIONS :

# DN8243 Polite, Leroy

NPI: 1740383017 LIC: DN8243

CERTIFICATIONS :

#011580

Hi-5 Children's Dentistry LLC

1202 Cypress Glen Circle

Kissimmee, FL 34741

hi-5childrensdentistry.com

(407) 810-0450

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN19542 Alvarez, Vanessa*

NPI: 1700166253 LIC: DN19542

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 207 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#FQHC016505

Osceola Community Health

Centers @ Kissimmee

1875 Fortune Rd.

Kissimmee, FL 34744

(407) 943-8600

Special Needs: Yes

English, Spanish

M-T 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 :

#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 :

#011438

St. Cloud Smiles, Inc.

2050 Old Hickory Tree Road, Ste I &

Saint Cloud, FL 34772

(407) 556-3969

Special Needs: Yes

English, Spanish, Vietnamese

M 8am - 5pm,

W-F 8am-5pm

# DN19154 Ball, Catherine

NPI: 1528371366 LIC: DN19154

CERTIFICATIONS :

# DN18003 Van, Jennifer

NPI: 1346447828 LIC: DN18003

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

ENDODONTICS

#015105

Greenberg Dental - Kissimmee

1379 E. Vine St

Kissimmee, FL 34744

(407) 933-8686

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN19321 Bienias, Russell

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015115

Greenberg Dental - South

Kissimmee

3233 S. John Young Pkwy

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 208 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Kissimmee, FL 34746

(407) 933-1226

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#014760

Greenberg Dental & Orthodontics

1050 Buenaventura Blvd

Kissimmee, FL 34743

(407) 392-1780

Special Needs: Yes

English, Spanish, Portuguese, Sign

Languages

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015330

Greenberg Dental & Orthodontics

5043 W. Irlo Bronson Memorial Hwy

Kissimmee, FL 34746

(407) 347-4865

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 8am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015118

Greenberg Dental & Orthodontics

- St. Cloud

4039 13Th St

Saint Cloud, FL 34769

(407) 892-1643

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

S 7am - 2pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#019999

Orlando Endodontic Specialists

-South

1956 E. Osceola Pkwy

Kissimmee, FL 34743

midfloridarootcanals.com

(407) 581-9500

Special Needs: No

English, Spanish, Creoles and Pidgins

English-based(other), Vietnamese

M-T 8am-5pm

W-F 8am-5pm

# DN16516 Aippersbach, William*

NPI: 1245368711 LIC: DN16516

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 209 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN16558 Isler, Aaron*

NPI: 1174627343 LIC: DN16558

CERTIFICATIONS :

# DN14871 Jungermann, Gretchen*

NPI: 1285693259 LIC: DN14871

CERTIFICATIONS :

# DN14322 Kharazi, Mehrbod*

NPI: 1902820509 LIC: DN14322

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

ORAL SURGEON

#015105

Greenberg Dental - Kissimmee

1379 E. Vine St

Kissimmee, FL 34744

(407) 933-8686

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN19573 Adams, Bryan

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015115

Greenberg Dental - South

Kissimmee

3233 S. John Young Pkwy

Kissimmee, FL 34746

(407) 933-1226

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#014760

Greenberg Dental & Orthodontics

1050 Buenaventura Blvd

Kissimmee, FL 34743

(407) 392-1780

Special Needs: Yes

English, Spanish, Portuguese, Sign

Languages

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015330

Greenberg Dental & Orthodontics

5043 W. Irlo Bronson Memorial Hwy

Kissimmee, FL 34746

(407) 347-4865

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 8am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015118

Greenberg Dental & Orthodontics

- St. Cloud

4039 13Th St

Saint Cloud, FL 34769

(407) 892-1643

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

S 7am - 2pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#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

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 210 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

ORTHODONTIST

#022382

Florida Orthodontic Associates

PLLC

595 Oak Commons Blvd, Ste C

Kissimmee, FL 34741

(407) 870-0717

Special Needs: No

M-T 7am-5pm

W-F 7am-5pm

# DN23098 Angeloni, Mark

NPI: 1881047843 LIC: DN23098

CERTIFICATIONS :

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#015105

Greenberg Dental - Kissimmee

1379 E. Vine St

Kissimmee, FL 34744

(407) 933-8686

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN17521 Aaron, Scott

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015115

Greenberg Dental - South

Kissimmee

3233 S. John Young Pkwy

Kissimmee, FL 34746

(407) 933-1226

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#014760

Greenberg Dental & Orthodontics

1050 Buenaventura Blvd

Kissimmee, FL 34743

(407) 392-1780

Special Needs: Yes

English, Spanish, Portuguese, Sign

Languages

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015330

Greenberg Dental & Orthodontics

5043 W. Irlo Bronson Memorial Hwy

Kissimmee, FL 34746

(407) 347-4865

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 8am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

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 211 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#015118

Greenberg Dental & Orthodontics

- St. Cloud

4039 13Th St

Saint Cloud, FL 34769

(407) 892-1643

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

S 7am - 2pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#015105

Greenberg Dental - Kissimmee

1379 E. Vine St

Kissimmee, FL 34744

(407) 933-8686

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015115

Greenberg Dental - South

Kissimmee

3233 S. John Young Pkwy

Kissimmee, FL 34746

(407) 933-1226

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#014760

Greenberg Dental & Orthodontics

1050 Buenaventura Blvd

Kissimmee, FL 34743

(407) 392-1780

Special Needs: Yes

English, Spanish, Portuguese, Sign

Languages

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015330

Greenberg Dental & Orthodontics

5043 W. Irlo Bronson Memorial Hwy

Kissimmee, FL 34746

(407) 347-4865

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 8am - 3pm

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 212 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015118

Greenberg Dental & Orthodontics

- St. Cloud

4039 13Th St

Saint Cloud, FL 34769

(407) 892-1643

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

S 7am - 2pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#011580

Hi-5 Children's Dentistry LLC

1202 Cypress Glen Circle

Kissimmee, FL 34741

hi-5childrensdentistry.com

(407) 810-0450

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN17078 Aliotti, Michelle*

NPI: 1124142062 LIC: DN17078

CERTIFICATIONS :

# DN21458 Bracho-Pacheco,

Andreina

NPI: 1073940730 LIC: DN21458

CERTIFICATIONS :

• Inhalation Sedation

# DN19471 Tabares, Miguel

NPI: 1194003210 LIC: DN19471

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

#015105

Greenberg Dental - Kissimmee

1379 E. Vine St

Kissimmee, FL 34744

(407) 933-8686

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015115

Greenberg Dental - South

Kissimmee

3233 S. John Young Pkwy

Kissimmee, FL 34746

(407) 933-1226

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#014760

Greenberg Dental & Orthodontics

1050 Buenaventura Blvd

Kissimmee, FL 34743

(407) 392-1780

Special Needs: Yes

English, Spanish, Portuguese, Sign

Languages

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015330

Greenberg Dental & Orthodontics

5043 W. Irlo Bronson Memorial Hwy

Kissimmee, FL 34746

(407) 347-4865

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 8am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#015118

Greenberg Dental & Orthodontics

- St. Cloud

4039 13Th St

Saint Cloud, FL 34769

(407) 892-1643

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

S 7am - 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 213 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

PROSTHODONTICS

#015105

Greenberg Dental - Kissimmee

1379 E. Vine St

Kissimmee, FL 34744

(407) 933-8686

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 8am - 2pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015115

Greenberg Dental - South

Kissimmee

3233 S. John Young Pkwy

Kissimmee, FL 34746

(407) 933-1226

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#014760

Greenberg Dental & Orthodontics

1050 Buenaventura Blvd

Kissimmee, FL 34743

(407) 392-1780

Special Needs: Yes

English, Spanish, Portuguese, Sign

Languages

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015330

Greenberg Dental & Orthodontics

5043 W. Irlo Bronson Memorial Hwy

Kissimmee, FL 34746

(407) 347-4865

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

S 8am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015118

Greenberg Dental & Orthodontics

- St. Cloud

4039 13Th St

Saint Cloud, FL 34769

(407) 892-1643

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

S 7am - 2pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

PALM BEACH COUNTY

DENTIST

#022639

America Dentistry

325 South Dixie Highway, Ste 5

Lake Worth, FL 33460

(561) 599-3250

Special Needs: Yes

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

S 10am - 2pm

# DN20126 Arciniegas, Francy

NPI: 1457791345 LIC: DN20126

CERTIFICATIONS :

#009809

Anitha Reddy D.M.D., P.A.

5700 Lake Worth Road, Ste 102

Lake Worth, FL 33463

(561) 965-1254

Special Needs: Yes

English, Spanish, Hindi

M-T 9am-5pm

W-Th 9am-5pm

# DN16053 Reddy, Anitha

NPI: 1003939489 LIC: DN16053

CERTIFICATIONS :

#020056

Art Family Dentistry

951 Sansburys Way Ste 201

West Palm Bch, FL 33411

(561) 660-8101

Special Needs: Yes

English, Spanish

T 9am - 5pm

Th-F 9am-5pm

S 9am - 3pm

# DN17929 Ramos, Idalmis

NPI: 1447452958 LIC: DN17929

CERTIFICATIONS :

#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 :

#014070

BGR Dental

1825 Forest Hill Blvd Ste #205

West Palm Beach, FL 33406

(561) 733-9099

Special Needs: No

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 9am-5pm

W-F 9am-5pm

# DN19392 Borda, Miguel

NPI: 1518254051 LIC: DN19392

CERTIFICATIONS :

• Inhalation Sedation

# DN5382 Goodman, Harold

NPI: 1003824905 LIC: DN5382

CERTIFICATIONS :

# DN20557 Morel, Adalgisa

NPI: 1831339308 LIC: DN20557

CERTIFICATIONS :

# DN8737 Newman, Donald

NPI: 1356476857 LIC: DN8737

CERTIFICATIONS :

# DN22977 Plunkett, Tousant

NPI: 1245681246 LIC: DN22977

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

NPI: 1881181501 LIC: DN23652

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 214 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#019414

Childrens Dental Care

5317 West Atlantic Ave Ste 101

Delray Beach, FL 33484

www.childrensdentalcaredelray.com

(561) 279-4080

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M 9am - 5pm, T 9am - 6pm

W-F 9am-5pm

# DN18678 Canola, Zulma

NPI: 1487942918 LIC: DN18678

CERTIFICATIONS :

# DN20557 Morel, Adalgisa

NPI: 1831339308 LIC: DN20557

CERTIFICATIONS :

# DN22675 Villarreal, Ruben

NPI: 1255860706 LIC: DN22675

CERTIFICATIONS :

• Inhalation Sedation

# DN16501 Wymann, Jamie

NPI: 1255457750 LIC: DN16501

CERTIFICATIONS :

#019689

Children's Dental Pl. of E. Boca

509 N.E. 20Th St

Boca Raton, FL 33431

(561) 620-1031

Special Needs: Yes

English, Spanish, Creoles and Pidgins

(other)

M-T 8am-5pm

W-F 8am-5pm

# DN14584 Handel, Michelle

NPI: 1083649347 LIC: DN14584

CERTIFICATIONS :

# DN13586 Herman, Joseph

NPI: 1205015070 LIC: DN13586

CERTIFICATIONS :

# DN19951 Herman, Lyle

NPI: 1538418488 LIC: DN19951

CERTIFICATIONS :

#007595

Children's Dental Pl. of

Wellington

1051 S. State Road # 7

Wellington, FL 33414

(561) 790-1909

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13586 Herman, Joseph

NPI: 1205015070 LIC: DN13586

CERTIFICATIONS :

# DN19951 Herman, Lyle

NPI: 1538418488 LIC: DN19951

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

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 215 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

# 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 :

#019500

Dale Pediatric Dentistry

1928 Commerce Lane Ste #1

Jupiter, FL 33458

(561) 210-7333

Special Needs: Yes

English, Russian, Spanish

M 8am - 5pm,

Th-F 8am-5pm

S 8am - 3pm

# DN21447 Dale, Jason

NPI: 1902270705 LIC: DN21447

CERTIFICATIONS :

• Inhalation Sedation

#013873

Dentalworks Studio of West Palm

Beach

6336 Forest Hill Blvd

Greenacres, FL 33415

www.dentalworksstudio.com

(561) 642-1177

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN18835 Ortega Perez, Claudia

NPI: 1043543606 LIC: DN18835

CERTIFICATIONS :

#CHC015386

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 216 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#019643

Emilia Isaza DDS PA

4886 Lake Worth Rd

Greenacres, FL 33463

(561) 202-9190

Special Needs: Yes

Spanish

M 11am - 5pm, T 9am - 5pm

W 9am-5pm,

# DN18767 Isaza, Emilia

NPI: 1629209630 LIC: DN18767

CERTIFICATIONS :

#018622

Family Dental Center

2763 S. Congress Ave

Palm Springs, FL 33461

(561) 429-4645

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 9am - 2pm

F 9am-7pm

S 9am - 1pm

# DN19855 Mesa, Tahimara

NPI: 1346596665 LIC: DN19855

CERTIFICATIONS :

# DN19438 Mesa-Estevez, Yusel

NPI: 1265720684 LIC: DN19438

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 :

#016225

Florida Kids Dental

3472 Forest Hill Blvd

West Palm Beach, FL 33406

(561) 619-4141

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20523 Munoz, N. Fernando

NPI: 1427115310 LIC: DN20523

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#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

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 :

#010864

Great Expressions Dental Centers

11682-B Us Hwy 1, Ste 60

North Palm Beach, FL 33408

(561) 624-2047

Special Needs: Yes

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

# DN24133 Brandao, Pamela

NPI: 1164080495 LIC: DN24133

CERTIFICATIONS :

# DN22642 Kadiyala, Sravanthi

NPI: 1952830879 LIC: DN22642

CERTIFICATIONS :

# DN18775 Luba, Kevin

NPI: 1801040399 LIC: DN18775

CERTIFICATIONS :

#016227

Great Expressions Dental Centers

930 N. Congress Ave Ste 200

Boynton Beach, FL 33426

(561) 732-6900

Special Needs: Yes

English, Russian, Creoles and Pidgins

(other), French, Portuguese, Spanish

M-T 8am-5pm

W-F 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 217 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

S 9am - 2pm

# DN24133 Brandao, Pamela

NPI: 1164080495 LIC: DN24133

CERTIFICATIONS :

# DN21396 Dagan, Shachar

NPI: 1447632542 LIC: DN21396

CERTIFICATIONS :

# DN17620 Harris, Ana

NPI: 1265605323 LIC: DN17620

CERTIFICATIONS :

# DN23092 Shimansky, Daniel

NPI: 1134634967 LIC: DN23092

CERTIFICATIONS :

#018488

Greenberg Dental & Orthodontics

7725 Lake Worth Rd

Lake Worth, FL 33467

(561) 508-9450

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN22704 Foreman, Kathleen

NPI: 1407377724 LIC: DN22704

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23796 Lajevardi, Navid

NPI: 1194212472 LIC: DN23796

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

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 :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN17455 Stein, Stacy

NPI: 1467637561 LIC: DN17455

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#020825

Greenberg Dental & Orthodontics

1230 Northlake Blvd

Lake Park, FL 33403

(561) 536-4463

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-4pm

W 11am-7pm, Th 10am-6pm,F

8am-4pm

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# 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 :

# DN22428 Salehi, Shiva

NPI: 1346696549 LIC: DN22428

CERTIFICATIONS :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#020827

Greenberg Dental & Orthodontics

4085 N. Haverhill Road, Ste C1

West Palm Beach, FL 33417

(561) 513-8031

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 8am-4pm

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# 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 :

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 218 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN22932 Rincon, Karolina

NPI: 1790293595 LIC: DN22932

CERTIFICATIONS :

# DN22428 Salehi, Shiva

NPI: 1346696549 LIC: DN22428

CERTIFICATIONS :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

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 :

#022013

Greenberg Dental & Orthodontics

956 Military Trl

West Palm Beach, FL 33415

(561) 284-8680

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

# 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 :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

CERTIFICATIONS :

#018559

Greenberg Dental & Orthodontics

14560 S. Military Trail, Ste B2

Delray Beach, FL 33484

(561) 323-7264

Special Needs: Yes

English, Spanish

M 11am - 7pm, T 7am - 3pm

Th-F 7am-3pm

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

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 :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN17455 Stein, Stacy

NPI: 1467637561 LIC: DN17455

CERTIFICATIONS :

# DN23211 Walker, Lindsay

NPI: 1093238842 LIC: DN23211

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

#017841

Jose M. Friman, DMD, PA

400 S. Dixie Hwy, Ste 13

Lake Worth, FL 33460

(561) 855-4061

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN21468 Friman, Jose

NPI: 1053796938 LIC: DN21468

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 219 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

#009687

Juana M. Geldres, D.D.S., P.A.

1911 Forest Hill Blvd

West Palm Beach, FL 33406

(561) 439-7400

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W 9am-12pm, Th 9am-5pm

# DN16169 Geldres, Juana

NPI: 1649212796 LIC: DN16169

CERTIFICATIONS :

#020578

Karen Reid D.M.D., PA

2826 Broadway, Ste 100

Riviera Beach, FL 33404

riverdental.net

(561) 842-4554

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 8am-5pm

W-Th 8am-5pm

# DN17197 Reid, Karen

NPI: 1942533088 LIC: DN17197

CERTIFICATIONS :

#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 :

#011602

Mario Hernandez, DDS, Inc

1870 Forest Hill Blvd Ste 103

Lake Clarke Shores, FL 33406

(561) 585-5891

Special Needs: Yes

English, Spanish

M 9am - 4pm, T 9am - 5pm

Th-F 9am-5pm

# DN13087 Hernandez, Mario

NPI: 1487820296 LIC: DN13087

CERTIFICATIONS :

#009961

Mil-Lake Dental Center P.A.

6137 Lake Worth Road

Greenacres, FL 33463

(561) 357-1009

Special Needs: Yes

Creoles and Pidgins

French-based(other), English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN13708 Victome, Robert

NPI: 1437238516 LIC: DN13708

CERTIFICATIONS :

#016173

Mini Mouths Dentistry for

Children

20401 State Road 7, Ste G14

Boca Raton, FL 33498

wwwmini-mouths.com

(561) 218-4012

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-Th 8am-5pm

# DN20969 Agudelo, Monica

NPI: 1578961751 LIC: DN20969

CERTIFICATIONS :

# DN21446 Granada-Ramirez, Erika

NPI: 1134503329 LIC: DN21446

CERTIFICATIONS :

• Inhalation Sedation

# DN20557 Morel, Adalgisa

NPI: 1831339308 LIC: DN20557

CERTIFICATIONS :

# DN24076 Savioli, Cynthia

NPI: 1336677756 LIC: DN24076

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

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

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 220 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#016558

Procare Dentistry

3509 W. Boynton Beach Blvd

Boynton Beach, FL 33436

www.procaredentist.com

(561) 737-5530

Special Needs: No

English, Spanish, Italian

M 9am - 1pm,

# DN14817 Allen, Melanie

NPI: 1649291949 LIC: DN14817

CERTIFICATIONS :

#017528

Procare Dentistry

12783 Forrest Hill Blvd #J

Wellington, FL 33414

procaredentist.com

(561) 793-5549

Special Needs: No

English, Spanish, Creoles and Pidgins

English-based(other), Italian

M 3pm - 6pm,

W 9am-7pm,

# DN14817 Allen, Melanie

NPI: 1649291949 LIC: DN14817

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 :

# 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 :

# 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

#009767

S. Congress Cosmetic & General

Dentistry

2976 S. Military Trail

West Palm Beach, FL 33415

(561) 434-6661

Special Needs: Yes

Spanish, English

M-T 9am-5pm

W-F 9am-5pm

# DN17929 Ramos, Idalmis

NPI: 1447452958 LIC: DN17929

CERTIFICATIONS :

# DN20107 Suarez Tabares, Lidia

NPI: 1780976795 LIC: DN20107

CERTIFICATIONS :

#009627

Sage Dental Group of Lake Worth

P.A.

1922 Lake Worth Rd

Lake Worth, FL 33461

(561) 547-5597

Special Needs: Yes

English, Spanish

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

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 221 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN20294 Slement, Gaby

NPI: 1003244179 LIC: DN20294

CERTIFICATIONS :

• Inhalation Sedation

# DN17837 Snider, Erica

NPI: 1073702767 LIC: DN17837

CERTIFICATIONS :

#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 :

#007513

Shapiro Family Dentistry

2247 Palm Beach Lakes Ste 104

West Palm Beach, FL 33409

www.shapirosmile.com

(561) 684-2282

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Haitian; Haitian

Creole

M-T 8am-6pm

W-Th 8am-6pm

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN22032 Sanchez, Jairo

NPI: 1376994236 LIC: DN22032

CERTIFICATIONS :

# DN15490 Shapiro, Dari

NPI: 1801099643 LIC: DN15490

CERTIFICATIONS :

• Inhalation Sedation

# DN15327 Shapiro, Seth

NPI: 1114136223 LIC: DN15327

CERTIFICATIONS :

#012861

Shapiro Family Dentistry

7805 Nw Beacon Square Blvd Ste 101

Boca Raton, FL 33487

www.shapirosmile.com

(561) 998-0901

Special Needs: No

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 9am-5pm

W-Th 9am-5pm

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN22032 Sanchez, Jairo

NPI: 1376994236 LIC: DN22032

CERTIFICATIONS :

# DN15490 Shapiro, Dari

NPI: 1801099643 LIC: DN15490

CERTIFICATIONS :

• Inhalation Sedation

# DN15327 Shapiro, Seth

NPI: 1114136223 LIC: DN15327

CERTIFICATIONS :

#021758

Shapiro Family Dentistry

9868 S State Road 7, Ste 200

Boynton Beach, FL 33472

www.sharpirofamilydentistry.com

(561) 877-3313

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 9am-5pm

W-F 9am-5pm

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN23031 Novak, Stephen

NPI: 1497267025 LIC: DN23031

CERTIFICATIONS :

# DN22032 Sanchez, Jairo

NPI: 1376994236 LIC: DN22032

CERTIFICATIONS :

# DN15490 Shapiro, Dari

NPI: 1801099643 LIC: DN15490

CERTIFICATIONS :

• Inhalation Sedation

# DN15327 Shapiro, Seth

NPI: 1114136223 LIC: DN15327

CERTIFICATIONS :

#015450

Sky Dental

625 Se 2Nd Ave, Ste D

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 :

#022481

Smile Creation Dental

3319 State Road 7, Ste 201

Wellington, FL 33449

(561) 557-2542

Special Needs: No

English, Spanish, Vietnamese

M-T 8am-5pm

W-F 8am-5pm

# DN20509 Vo, Danny

NPI: 1629181698 LIC: DN20509

CERTIFICATIONS :

#014989

Super Smiles Pediatric Dentistry

& Orthodontics

4800 Linton Blvd, Ste D505

Delray Beach, FL 33445

supersmilesfl.com

(561) 403-5429

Special Needs: Yes

English, Spanish

M-T 8am-5pm

# DN20926 Woodruff, Joshua

NPI: 1013331644 LIC: DN20926

CERTIFICATIONS :

#012782

Tavory Dentistry, PA

19635 State Rd 7 Ste 51

Boca Raton, FL 33498

(561) 483-9118

Special Needs: Yes

Spanish, Hebrew

M 9am - 5pm,

W 10am-4pm, Th 9am-5pm

S 9am - 2pm

# DN16456 Tavory, Yaron

NPI: 1649362088 LIC: DN16456

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 :

#018488

Greenberg Dental & Orthodontics

7725 Lake Worth Rd

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 222 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Lake Worth, FL 33467

(561) 508-9450

Special Needs: Yes

English, Spanish

M-T 7am-3pm

W-Th 11am-7pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

#020825

Greenberg Dental & Orthodontics

1230 Northlake Blvd

Lake Park, FL 33403

(561) 536-4463

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-4pm

W 11am-7pm, Th 10am-6pm,F

8am-4pm

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

#020827

Greenberg Dental & Orthodontics

4085 N. Haverhill Road, Ste C1

West Palm Beach, FL 33417

(561) 513-8031

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 8am-4pm

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

#010757

Jupiter Dental Group

175 Toney Penna Drive, Ste 105

Jupiter, FL 33458

(561) 745-3118

Special Needs: Yes

English, Russian, Spanish

M 9am - 5pm,

W-F 9am-5pm

# DN10933 Kosakoski, Edward

NPI: 1457482168 LIC: DN10933

CERTIFICATIONS :

# DN11671 Porras, Edgar

NPI: 1659467785 LIC: DN11671

CERTIFICATIONS :

#009627

Sage Dental Group of Lake Worth

P.A.

1922 Lake Worth Rd

Lake Worth, FL 33461

(561) 547-5597

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15780 Ahn, Sunghee

NPI: 1790816882 LIC: DN15780

CERTIFICATIONS :

• Board Certification

# DN20550 Gankin, Mikhail

NPI: 1114112935 LIC: DN20550

CERTIFICATIONS :

#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

# DN20550 Gankin, Mikhail

NPI: 1114112935 LIC: DN20550

CERTIFICATIONS :

#010647

Towncare Dental of Forest Hill

3027 Forest Hill Blvd, Ste A3

West Palm Beach, FL 33406

(561) 433-4330

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN10933 Kosakoski, Edward

NPI: 1457482168 LIC: DN10933

CERTIFICATIONS :

# DN22214 Sarmiento, Jeffrey

NPI: 1184177560 LIC: DN22214

CERTIFICATIONS :

# DN18596 Selman, Anas

NPI: 1134354491 LIC: DN18596

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

#016227

Great Expressions Dental Centers

930 N. Congress Ave Ste 200

Boynton Beach, FL 33426

(561) 732-6900

Special Needs: Yes

English, Russian, Creoles and Pidgins

(other), French, Portuguese, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 2pm

# DN22442 Turner, Mark

NPI: 1003252685 LIC: DN22442

CERTIFICATIONS :

• Inhalation 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

#010757

Jupiter Dental Group

175 Toney Penna Drive, Ste 105

Jupiter, FL 33458

(561) 745-3118

Special Needs: Yes

English, Russian, Spanish

M 9am - 5pm,

W-F 9am-5pm

# DN16630 Patel, Nishul

NPI: 1952558439 LIC: DN16630

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#010647

Towncare Dental of Forest Hill

3027 Forest Hill Blvd, Ste A3

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 223 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

West Palm Beach, FL 33406

(561) 433-4330

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16630 Patel, Nishul

NPI: 1952558439 LIC: DN16630

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#019650

Cooper Orthodontic LLC

685 Royal Palm Beach Blvd. Ste 202

Royal Palm Beach, FL 33411

www.smilesbycooper.com

(561) 790-0319

Special Needs: Yes

English, Spanish

M 8am - 6pm, T 8am - 5pm

# DN18379 Cooper, Andrew

NPI: 1710206149 LIC: DN18379

CERTIFICATIONS :

# DN20037 Cooper, Justin

NPI: 1245519768 LIC: DN20037

CERTIFICATIONS :

# DN21859 Loebl, Daniela

NPI: 1457822371 LIC: DN21859

CERTIFICATIONS :

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

CERTIFICATIONS :

#019200

Cooper Orthodontics

509 Ne 20Th Street

Boca Raton, FL 33431

(561) 620-1067

Special Needs: Yes

English, Spanish

W-Th 8am-5pm

# DN18379 Cooper, Andrew

NPI: 1710206149 LIC: DN18379

CERTIFICATIONS :

# DN20037 Cooper, Justin

NPI: 1245519768 LIC: DN20037

CERTIFICATIONS :

# DN20383 Fernandez-Feo, Carlos

NPI: 1417383092 LIC: DN20383

CERTIFICATIONS :

# DN21521 Lieberman, Ian

NPI: 1497265045 LIC: DN21521

CERTIFICATIONS :

# DN21859 Loebl, Daniela

NPI: 1457822371 LIC: DN21859

CERTIFICATIONS :

# DN20300 Matamoros, Marcela

NPI: 1417311846 LIC: DN20300

CERTIFICATIONS :

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

CERTIFICATIONS :

#019201

Cooper Orthodontics

9181 Glades Road #120

Boca Raton, FL 33434

(561) 558-9467

Special Needs: Yes

English, Spanish

M-T 8am-5pm

# DN18379 Cooper, Andrew

NPI: 1710206149 LIC: DN18379

CERTIFICATIONS :

# DN20037 Cooper, Justin

NPI: 1245519768 LIC: DN20037

CERTIFICATIONS :

# DN20383 Fernandez-Feo, Carlos

NPI: 1417383092 LIC: DN20383

CERTIFICATIONS :

# DN21859 Loebl, Daniela

NPI: 1457822371 LIC: DN21859

CERTIFICATIONS :

# DN20300 Matamoros, Marcela

NPI: 1417311846 LIC: DN20300

CERTIFICATIONS :

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

CERTIFICATIONS :

#019203

Cooper Orthodontics

1708 N. Federal Hwy

Lake Worth, FL 33460

(561) 588-0319

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN18379 Cooper, Andrew

NPI: 1710206149 LIC: DN18379

CERTIFICATIONS :

# DN20037 Cooper, Justin

NPI: 1245519768 LIC: DN20037

CERTIFICATIONS :

# DN20383 Fernandez-Feo, Carlos

NPI: 1417383092 LIC: DN20383

CERTIFICATIONS :

# DN21521 Lieberman, Ian

NPI: 1497265045 LIC: DN21521

CERTIFICATIONS :

# DN21859 Loebl, Daniela

NPI: 1457822371 LIC: DN21859

CERTIFICATIONS :

# DN20300 Matamoros, Marcela

NPI: 1417311846 LIC: DN20300

CERTIFICATIONS :

# DN20629 Sedeno, Eddy

NPI: 1578005179 LIC: DN20629

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

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#016593

Goldenberg Orthodontics PA

9250 Glades Rd, Ste 208

Boca Raton, FL 33434

www.goldenbergorthodontics.com

(561) 756-9227

Special Needs: Yes

English, Spanish, Hebrew

M 8am - 7pm, T 8am - 5pm

W 8am-5pm, Th 8am-7pm,F 8am-3pm

# DN21140 Goldenberg, Marc

NPI: 1346622826 LIC: DN21140

CERTIFICATIONS :

#016125

Shelling Orthodontics

19615 State Road 7, Ste 33

Boca Raton, FL 33498

(561) 477-4844

Special Needs: Yes

English, Spanish

M 10am - 7pm, T 9am - 5pm

W 10am-7pm, Th 9am-5pm,F

10am-5pm

# DN17192 Shelling, Robert

NPI: 1225210545 LIC: DN17192

CERTIFICATIONS :

#009287

Vargas Orthodontics

550 Heritage Dr. Ste 170

Jupiter, FL 33458

vargasorthodontics.com

(561) 775-7007

Special Needs: Yes

Spanish

M 7am - 5pm, T 7am - 6pm

W 8am-5pm, Th 7am-5pm,F 8am-5pm

# DN15884 Vargas, Alberto*

NPI: 1982731725 LIC: DN15884

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#022294

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 224 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#010450

Children & Pediatric Dentistry of

Boca

600 S. Dixie Hwy, Ste 207

Boca Raton, FL 33432

www.adentistjustforkids.com

(561) 391-6800

Special Needs: Yes

English, Spanish

T 8am - 5pm

# DN13881 Jimenez, Francisco

NPI: 1588855738 LIC: DN13881

CERTIFICATIONS :

• Inhalation Sedation

#010451

Children & Pediatric Dentistry of

Wellington

12798 W. Forest Hill Blvd, Ste 305

Wellington, FL 33414

(561) 793-7515

Special Needs: Yes

English, Spanish

M 8am - 5pm,

W-Th 8am-5pm

# DN13881 Jimenez, Francisco

NPI: 1588855738 LIC: DN13881

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

# 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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

# 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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

# 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

# DN15880 Tibby, Tamara-Kay

NPI: 1508893850 LIC: DN15880

CERTIFICATIONS :

• Board Certification

# DN19391 Zangeneh, Yasmine

NPI: 1841586567 LIC: DN19391

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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#020338

Functional Facial Orthopedics

13421 South Shore Blvd, Ste 203

West Palm Beach, FL 33414

(561) 215-1603

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN17401 Toledo, Nilsa

NPI: 1174655542 LIC: DN17401

CERTIFICATIONS :

• Board Certification

#014965

Gators Tooth Team

7301 W. Palmetto Pk Road Ste 203B

Boca Raton, FL 33433

www.gatorstoothteam.com

(561) 391-6066

Special Needs: Yes

Creoles and Pidgins

French-based(other), English,

Portuguese, Spanish

M 12pm - 6pm, T 8am - 5pm

W-F 8am-5pm

# DN21680 Aponte-Rodriguez,

Suheily

NPI: 1396003950 LIC: DN21680

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN19448 Arevalo, Oscar

NPI: 1457443285 LIC: DN19448

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21331 Lolo, Patrick

NPI: 1609257484 LIC: DN21331

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

# DN24006 Miranda Bucio, Paula

NPI: 1336498625 LIC: DN24006

CERTIFICATIONS :

# DN22180 Puig, Christina

NPI: 1679954788 LIC: DN22180

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 225 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN17387 Roldan, Rosie

NPI: 1912951948 LIC: DN17387

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

# DN21754 Toquica, Tatiana

NPI: 1649598087 LIC: DN21754

CERTIFICATIONS :

• Inhalation Sedation

#010864

Great Expressions Dental Centers

11682-B Us Hwy 1, Ste 60

North Palm Beach, FL 33408

(561) 624-2047

Special Needs: Yes

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

# DN20688 Acheampong, Emmanuel

NPI: 1407122252 LIC: DN20688

CERTIFICATIONS :

• Inhalation Sedation

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN16232 Starkman, Sharlene Yap

NPI: 1265656797 LIC: DN16232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#016227

Great Expressions Dental Centers

930 N. Congress Ave Ste 200

Boynton Beach, FL 33426

(561) 732-6900

Special Needs: Yes

English, Russian, Creoles and Pidgins

(other), French, Portuguese, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 9am - 2pm

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#022268

Junior Smiles

9930 Clint Moore Road, Ste D-102

Boca Raton, FL 33496

(561) 210-7788

Special Needs: Yes

English, Spanish

M 9am - 5pm, T 8am - 5pm

W 9am-5pm, Th 8am-5pm,F 9am-5pm

# DN21755 Popper, Drew*

NPI: 1922407964 LIC: DN21755

CERTIFICATIONS :

• Inhalation Sedation

#EV263642

Kidzvil Pediatric Dentistry

6045 Hagen Ranch Rd Ste 3

Lake Worth, FL 33467

(561) 845-7374

Special Needs: Yes

English

M 8am - 5pm, T 9am - 6pm

W-Th 8am-5pm

# DN21385 Sainvil, Irwine

NPI: 1801299177 LIC: DN21385

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#022818

Little By Little Pediatric Dentistry

Corp

1405 N. Alternate Aia, Ste 106

Jupiter, FL 33469

(561) 770-3000

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 1pm

# DN21700 Pinero Correa, Rosario

NPI: 1013279769 LIC: DN21700

CERTIFICATIONS :

• Conscious Sedation

• Intravenous Sedation

• Oral / Enteral Sedation

• Pediatric Conscious Sedation

#012438

Little Smiles Dental #3

3469 W. Boynton Beach Blvd Ste 20

Boynton Beach, FL 33436

(561) 736-8755

Special Needs: Yes

Spanish, Arabic, English

M 8am - 6pm,

W-F 8am-2pm

# DN15894 Cortes, Bayardo

NPI: 1174604896 LIC: DN15894

CERTIFICATIONS :

• Inhalation Sedation

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#017770

Little Smiles Dental #4

1708 N. Federal Hwy

Lake Worth, FL 33460

www.littlesmiledental.com

(561) 588-2025

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN16953 Cortes, Gonzalo

NPI: 1740480417 LIC: DN16953

CERTIFICATIONS :

• Inhalation Sedation

#011294

Main Street Children's Dentistry

5440 Military Trail, Ste 11

Jupiter, FL 33458

www.mainstreetsmiles.com

(561) 745-2881

Special Needs: Yes

English, Spanish

M 7am - 5pm,

W-F 7am-5pm

# DN18692 Michaud, Christie

NPI: 1922238815 LIC: DN18692

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#011293

Main Street Children's Dentistry

of Wellington

11903 Southern Blvd, Ste 102

Royal Palm Beach, FL 33411

(561) 422-2940

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN22345 Carmona, Francis

NPI: 1336691344 LIC: DN22345

CERTIFICATIONS :

• Inhalation Sedation

# DN21753 Levin, Shelly

NPI: 1023351715 LIC: DN21753

CERTIFICATIONS :

• Inhalation Sedation

#021704

Miller Pediatric Dentistry, PA

391 N. Congress Ave

Boynton Beach, FL 33426

www.millerpdo.com

(561) 336-6560

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21113 Miller, Mitchell

NPI: 1336554864 LIC: DN21113

CERTIFICATIONS :

• Inhalation Sedation

#016173

Mini Mouths Dentistry for

Children

20401 State Road 7, Ste G14

Boca Raton, FL 33498

wwwmini-mouths.com

(561) 218-4012

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 226 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Spanish, Portuguese

M-T 8am-5pm

W-Th 8am-5pm

# DN20130 Avman, Selin

NPI: 1750636049 LIC: DN20130

CERTIFICATIONS :

• Inhalation Sedation

# DN19597 Rosenfeld, Dalia

NPI: 1134496037 LIC: DN19597

CERTIFICATIONS :

• Inhalation Sedation

#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

# DN22981 Socarras Diaz, Liliem

NPI: 1427403666 LIC: DN22981

CERTIFICATIONS :

#009627

Sage Dental Group of Lake Worth

P.A.

1922 Lake Worth Rd

Lake Worth, FL 33461

(561) 547-5597

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# 059724-1 Gelber, Zachary

NPI: 1437542081 LIC: 059724-1

CERTIFICATIONS :

# DN21755 Popper, Drew

NPI: 1922407964 LIC: DN21755

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

# 059724-1 Gelber, Zachary

NPI: 1437542081 LIC: 059724-1

CERTIFICATIONS :

#007513

Shapiro Family Dentistry

2247 Palm Beach Lakes Ste 104

West Palm Beach, FL 33409

www.shapirosmile.com

(561) 684-2282

Special Needs: Yes

English, Spanish, Creoles and Pidgins

French-based(other), Haitian; Haitian

Creole

M-T 8am-6pm

W-Th 8am-6pm

# DN17836 Smith, Christina

NPI: 1104963149 LIC: DN17836

CERTIFICATIONS :

• Inhalation Sedation

#012861

Shapiro Family Dentistry

7805 Nw Beacon Square Blvd Ste 101

Boca Raton, FL 33487

www.shapirosmile.com

(561) 998-0901

Special Needs: No

English, Spanish, Creoles and Pidgins

French-based(other)

M-T 9am-5pm

W-Th 9am-5pm

# DN17836 Smith, Christina

NPI: 1104963149 LIC: DN17836

CERTIFICATIONS :

• Inhalation Sedation

#021758

Shapiro Family Dentistry

9868 S State Road 7, Ste 200

Boynton Beach, FL 33472

www.sharpirofamilydentistry.com

(561) 877-3313

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 9am-5pm

W-F 9am-5pm

# DN17836 Smith, Christina

NPI: 1104963149 LIC: DN17836

CERTIFICATIONS :

• Inhalation Sedation

#015450

Sky Dental

625 Se 2Nd Ave, Ste D

Boynton Beach, FL 33435

(561) 739-3222

Special Needs: No

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN22981 Socarras Diaz, Liliem

NPI: 1427403666 LIC: DN22981

CERTIFICATIONS :

#014989

Super Smiles Pediatric Dentistry

& Orthodontics

4800 Linton Blvd, Ste D505

Delray Beach, FL 33445

supersmilesfl.com

(561) 403-5429

Special Needs: Yes

English, Spanish

M-T 8am-5pm

# DN21459 Brady, Tiffany

NPI: 1407292824 LIC: DN21459

CERTIFICATIONS :

• Inhalation Sedation

# DN20401 Buscemi, Amanda

NPI: 1669808572 LIC: DN20401

CERTIFICATIONS :

• Inhalation Sedation

# DN21064 Storch, Dana

NPI: 1801219563 LIC: DN21064

CERTIFICATIONS :

• Inhalation Sedation

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 :

#010757

Jupiter Dental Group

175 Toney Penna Drive, Ste 105

Jupiter, FL 33458

(561) 745-3118

Special Needs: Yes

English, Russian, Spanish

M 9am - 5pm,

W-F 9am-5pm

# DN17440 Oliver, Francisco

NPI: 1437316510 LIC: DN17440

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

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 227 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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

#021758

Shapiro Family Dentistry

9868 S State Road 7, Ste 200

Boynton Beach, FL 33472

www.sharpirofamilydentistry.com

(561) 877-3313

Special Needs: Yes

English, Spanish, Creoles and Pidgins

English-based(other)

M-T 9am-5pm

W-F 9am-5pm

# DN18002 Fotek, Pawel

NPI: 1336331693 LIC: DN18002

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

PASCO COUNTY

DENTIST

#020478

Advanced Dental Care Specialist

Corp

6640 Embassy Blvd

Port Richey, FL 34668

(727) 847-9631

Special Needs: Yes

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN15819 Estrada, Jaime

NPI: 1881896371 LIC: DN15819

CERTIFICATIONS :

• Conscious Sedation

#013243

Advanced Dental Care Specialist,

Inc

13736 Little Road

Hudson, FL 34667

(727) 869-3886

Special Needs: No

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN15819 Estrada, Jaime

NPI: 1881896371 LIC: DN15819

CERTIFICATIONS :

• Conscious Sedation

#021786

Children and Teen Dental Group

of Florida

5245 Us Highway 19

New Port Richey, FL 34652

(727) 847-3113

Special Needs: Yes

English, Spanish, Vietnamese

M-T 8am-5pm

W-F 8am-5pm

# DN16260 Adewunmi, Mopelola

NPI: 1477605053 LIC: DN16260

CERTIFICATIONS :

• Inhalation Sedation

# DN20260 Chang, Steven

NPI: 1649611799 LIC: DN20260

CERTIFICATIONS :

• Inhalation Sedation

# DN19041 Chapagain, Shweta

NPI: 1346561396 LIC: DN19041

CERTIFICATIONS :

• Inhalation Sedation

# DN16308 Dao, Thieu

NPI: 1881810158 LIC: DN16308

CERTIFICATIONS :

• Inhalation Sedation

# DN23038 Hernandez, Christine

NPI: 1891216784 LIC: DN23038

CERTIFICATIONS :

• Inhalation Sedation

# DN13761 Mauricio, Margaret

NPI: 1558354209 LIC: DN13761

CERTIFICATIONS :

• Inhalation Sedation

# DN22068 Paula, Kelly

NPI: 1487107470 LIC: DN22068

CERTIFICATIONS :

• Inhalation Sedation

# DN15728 Pham, Nguyen

NPI: 1750483434 LIC: DN15728

CERTIFICATIONS :

• Inhalation Sedation

# DN15319 Pham, Thanh

NPI: 1700947660 LIC: DN15319

CERTIFICATIONS :

• Inhalation Sedation

# DN16447 Siemiet, Erika

NPI: 1770709057 LIC: DN16447

CERTIFICATIONS :

• Inhalation Sedation

# DN22093 St Charles II, Jay

NPI: 1336591452 LIC: DN22093

CERTIFICATIONS :

• Inhalation Sedation

#021787

Children and Teen Dental Group

of Florida

6606 Forest Ave

New Port Richey, FL 34653

www.cobbedental.com

(727) 849-2454

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN20260 Chang, Steven

NPI: 1649611799 LIC: DN20260

CERTIFICATIONS :

• Inhalation Sedation

# DN19041 Chapagain, Shweta

NPI: 1346561396 LIC: DN19041

CERTIFICATIONS :

• Inhalation Sedation

# DN16308 Dao, Thieu

NPI: 1881810158 LIC: DN16308

CERTIFICATIONS :

• Inhalation Sedation

# DN23038 Hernandez, Christine

NPI: 1891216784 LIC: DN23038

CERTIFICATIONS :

• Inhalation Sedation

# DN13761 Mauricio, Margaret

NPI: 1558354209 LIC: DN13761

CERTIFICATIONS :

• Inhalation Sedation

# DN22068 Paula, Kelly

NPI: 1487107470 LIC: DN22068

CERTIFICATIONS :

• Inhalation Sedation

# DN15728 Pham, Nguyen

NPI: 1750483434 LIC: DN15728

CERTIFICATIONS :

• Inhalation Sedation

# DN15319 Pham, Thanh

NPI: 1700947660 LIC: DN15319

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 228 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN16447 Siemiet, Erika

NPI: 1770709057 LIC: DN16447

CERTIFICATIONS :

• Inhalation Sedation

# DN22093 St Charles II, Jay

NPI: 1336591452 LIC: DN22093

CERTIFICATIONS :

• Inhalation Sedation

#CHC10110

DOH - Pasco County Health

Department

10841 Little Rd

New Port Richey, FL 34654

(727) 619-0284

Special Needs: No

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# HAD27 Genho, Beth

NPI: 1942491154 LIC: HAD27

CERTIFICATIONS :

# DN14205 Melean, Alfonso

NPI: 1609845031 LIC: DN14205

CERTIFICATIONS :

# DN16403 Nagabandi, Padma

NPI: 1780743161 LIC: DN16403

CERTIFICATIONS :

# DN11385 Traul Jr., Robert

NPI: 1982734257 LIC: DN11385

CERTIFICATIONS :

#CHC10111

DOH - Pasco County Health

Department

37615 Martin Luther King Blvd

Dade City, FL 33523

(352) 521-1450

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# HAD27 Genho, Beth

NPI: 1942491154 LIC: HAD27

CERTIFICATIONS :

# DN14205 Melean, Alfonso

NPI: 1609845031 LIC: DN14205

CERTIFICATIONS :

# DN16403 Nagabandi, Padma

NPI: 1780743161 LIC: DN16403

CERTIFICATIONS :

#010862

Great Expressions Dental Centers

1748 Bruce B. Downs Blvd, Ste 125

Wesley Chapel, FL 33543

(813) 907-1151

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN21523 Cardenas, Astrid

NPI: 1962831644 LIC: DN21523

CERTIFICATIONS :

• Inhalation Sedation

# DN20562 Decambra, Nicole

NPI: 1790125821 LIC: DN20562

CERTIFICATIONS :

# DN21817 Ferrer Torres, Dario

NPI: 1750708129 LIC: DN21817

CERTIFICATIONS :

• Inhalation Sedation

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN13640 Schaffner, Daniel

NPI: 1548339815 LIC: DN13640

CERTIFICATIONS :

• Inhalation Sedation

#010871

Great Expressions Dental Centers

7950 Gall Blvd

Zephyrhills, FL 33541

(813) 715-1271

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN21523 Cardenas, Astrid

NPI: 1962831644 LIC: DN21523

CERTIFICATIONS :

• Inhalation Sedation

# DN22728 Franz, Rachel

NPI: 1881114825 LIC: DN22728

CERTIFICATIONS :

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN24319 Lee, Vera

NPI: 1326271842 LIC: DN24319

CERTIFICATIONS :

# DN23658 LePochat, Christina

NPI: 1316438120 LIC: DN23658

CERTIFICATIONS :

# DN17676 Malik, Shazia

NPI: 1811077621 LIC: DN17676

CERTIFICATIONS :

• Inhalation Sedation

# DN15142 Reed, Samantha

NPI: 1104042456 LIC: DN15142

CERTIFICATIONS :

• Inhalation Sedation

# DN22138 Sandesara, Pooja

NPI: 1396108296 LIC: DN22138

CERTIFICATIONS :

• Inhalation Sedation

# DN20669 Spouh, Mohammad

NPI: 1902210842 LIC: DN20669

CERTIFICATIONS :

#010997

Great Expressions Dental Centers

2091 Collier Parkway

Land O Lakes, FL 34639

(813) 948-6290

Special Needs: No

English

M-T 8am-5pm

W-F 8am-5pm

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN20075 Lepore, Krystina

NPI: 1164781761 LIC: DN20075

CERTIFICATIONS :

#015834

Greenberg Dental & Orthodontics

3338 Us Highway 19

Holiday, FL 34691

(727) 359-0371

Special Needs: No

English, Spanish

M-T 8am-4pm

W-Th 11am-7pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

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 229 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#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 :

#011735

Smileville Dental Center, PA

26827 Foggy Creek Rd Ste 103

Wesley Chapel, FL 33544

www.smilevillefl.com

(813) 994-4777

Special Needs: No

English, Spanish

T 9am - 3pm

W-Th 9am-3pm

# DN18930 Mejias, Karen

NPI: 1346572625 LIC: DN18930

CERTIFICATIONS :

• Inhalation Sedation

ENDODONTICS

#015834

Greenberg Dental & Orthodontics

3338 Us Highway 19

Holiday, FL 34691

(727) 359-0371

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 230 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

M-T 8am-4pm

W-Th 11am-7pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

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 :

ORTHODONTIST

#017633

Blue Wave Ortho Partners, PLLC

2234 Native Woods Lane #102

Wesley Chapel, FL 33544

www.bluewaveortho.com

(813) 968-2483

Special Needs: Yes

English, Spanish

T 8am - 5pm

# DN21728 Cetta, Christopher

NPI: 1689893240 LIC: DN21728

CERTIFICATIONS :

#019499

Florida Orthodontic Associates

5312 S.R. 54

New Port Richey, FL 34652

(727) 205-0036

Special Needs: Yes

English, Spanish

M-T 7am-5pm

W-F 7am-5pm

# DN23098 Angeloni, Mark

NPI: 1881047843 LIC: DN23098

CERTIFICATIONS :

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#015834

Greenberg Dental & Orthodontics

3338 Us Highway 19

Holiday, FL 34691

(727) 359-0371

Special Needs: No

English, Spanish

M-T 8am-4pm

W-Th 11am-7pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#017633

Blue Wave Ortho Partners, PLLC

2234 Native Woods Lane #102

Wesley Chapel, FL 33544

www.bluewaveortho.com

(813) 968-2483

Special Needs: Yes

English, Spanish

T 8am - 5pm

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

CERTIFICATIONS :

• Inhalation Sedation

#021786

Children and Teen Dental Group

of Florida

5245 Us Highway 19

New Port Richey, FL 34652

(727) 847-3113

Special Needs: Yes

English, Spanish, Vietnamese

M-T 8am-5pm

W-F 8am-5pm

# DN12365 Montgomery, Nancy

NPI: 1538200282 LIC: DN12365

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#021787

Children and Teen Dental Group

of Florida

6606 Forest Ave

New Port Richey, FL 34653

www.cobbedental.com

(727) 849-2454

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN12365 Montgomery, Nancy

NPI: 1538200282 LIC: DN12365

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#010278

Dr. Bee Pediatric Dentistry

2242 Ashley Oaks Circle

Wesley Chapel, FL 33544

www.drbeepd.com

(813) 991-5300

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-F 8am-5pm

# DN17854 Bezerra, Francisco

NPI: 1659580595 LIC: DN17854

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21117 Nensey, Zara

NPI: 1346658408 LIC: DN21117

CERTIFICATIONS :

• Inhalation Sedation

#015515

Dr. Bee Pediatric Dentistry

6935 Land O Lakes Blvd

Land O Lakes, FL 34638

(813) 530-3300

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-F 8am-5pm

# DN17854 Bezerra, Francisco

NPI: 1659580595 LIC: DN17854

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN22481 Fernandez, Danielle

NPI: 1851707079 LIC: DN22481

CERTIFICATIONS :

• Inhalation Sedation

# DN21117 Nensey, Zara

NPI: 1346658408 LIC: DN21117

CERTIFICATIONS :

• Inhalation Sedation

#019436

Florida Pediatric Dental Associates

5312 State Road 54

New Port Richey, FL 34652

(727) 205-0036

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13950 Blankenship, Susan

NPI: 1679699383 LIC: DN13950

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 231 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN23234 Cummings, Marloin

NPI: 1467545087 LIC: DN23234

CERTIFICATIONS :

# DN24376 McNair, Jonathan

NPI: 1841642154 LIC: DN24376

CERTIFICATIONS :

# DN14677 Vales, Ana-Marai

NPI: 1215146493 LIC: DN14677

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#010862

Great Expressions Dental Centers

1748 Bruce B. Downs Blvd, Ste 125

Wesley Chapel, FL 33543

(813) 907-1151

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15989 Jafarnia, Bahareh

NPI: 1407905730 LIC: DN15989

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21471 Monteleone, Chelsea

NPI: 1124497821 LIC: DN21471

CERTIFICATIONS :

• Inhalation Sedation

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010871

Great Expressions Dental Centers

7950 Gall Blvd

Zephyrhills, FL 33541

(813) 715-1271

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN24084 Cataldo, Dorothy

NPI: 1053849232 LIC: DN24084

CERTIFICATIONS :

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#015834

Greenberg Dental & Orthodontics

3338 Us Highway 19

Holiday, FL 34691

(727) 359-0371

Special Needs: No

English, Spanish

M-T 8am-4pm

W-Th 11am-7pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

#011254

McIlwain Family Dentistry

-HOSPITAL ONLY/REFERRAL

ONLY

26908 Foggy Creek Road #101

Wesley Chapel, FL 33544

(813) 991-9893

Special Needs: No

English, Spanish

M-T 7am-5pm

W-Th 7am-5pm

# DN16024 McIlwain, Michael*

NPI: 1710225362 LIC: DN16024

CERTIFICATIONS :

• Board Certification

• Pediatric Conscious Sedation

#011110

No Sugar Bugs Club Children's

Dentistry

8804 Hawbuck St

Trinity, FL 34655

www.nosugarbugs.com

(727) 478-3210

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN18989 Chuong, Christopher

NPI: 1992017156 LIC: DN18989

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN24037 Hoang, Tranchau

NPI: 1629599774 LIC: DN24037

CERTIFICATIONS :

#011311

Sea of Smiles, Inc.

3737 Maryweather Lane #101

Wesley Chapel, FL 33544

(813) 528-8717

Special Needs: Yes

English

M-T 8am-4pm

W-Th 8am-4pm

# DN17430 LaPresti, Lisa

NPI: 1386787430 LIC: DN17430

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

PERIODONTICS

#015834

Greenberg Dental & Orthodontics

3338 Us Highway 19

Holiday, FL 34691

(727) 359-0371

Special Needs: No

English, Spanish

M-T 8am-4pm

W-Th 11am-7pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

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 :

#021708

Children and Teen Dental Group

of Florida

2707 Tampa Road

Palm Harbor, FL 34684

(727) 785-6521

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-F 8am-5pm

# DN16260 Adewunmi, Mopelola

NPI: 1477605053 LIC: DN16260

CERTIFICATIONS :

• Inhalation Sedation

# DN20260 Chang, Steven

NPI: 1649611799 LIC: DN20260

CERTIFICATIONS :

• Inhalation Sedation

# DN19041 Chapagain, Shweta

NPI: 1346561396 LIC: DN19041

CERTIFICATIONS :

• Inhalation Sedation

# DN16308 Dao, Thieu

NPI: 1881810158 LIC: DN16308

CERTIFICATIONS :

• Inhalation Sedation

# DN23038 Hernandez, Christine

NPI: 1891216784 LIC: DN23038

CERTIFICATIONS :

• Inhalation Sedation

# DN13761 Mauricio, Margaret

NPI: 1558354209 LIC: DN13761

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 232 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN22068 Paula, Kelly

NPI: 1487107470 LIC: DN22068

CERTIFICATIONS :

• Inhalation Sedation

# DN15728 Pham, Nguyen

NPI: 1750483434 LIC: DN15728

CERTIFICATIONS :

• Inhalation Sedation

# DN15319 Pham, Thanh

NPI: 1700947660 LIC: DN15319

CERTIFICATIONS :

• Inhalation Sedation

# DN16447 Siemiet, Erika

NPI: 1770709057 LIC: DN16447

CERTIFICATIONS :

• Inhalation Sedation

# DN22093 St Charles II, Jay

NPI: 1336591452 LIC: DN22093

CERTIFICATIONS :

• Inhalation Sedation

#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

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

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 233 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(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

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 :

#010933

E & G Family Dentistry, Inc

28913 Us Hwy 19 N

Clearwater, FL 33761

(727) 772-8772

Special Needs: Yes

English, Spanish

M 9am - 6pm,

W 9am-6pm, Th 9am-3pm

# DN13662 Miller, Dwayne*

NPI: 1396835609 LIC: DN13662

CERTIFICATIONS :

• Inhalation Sedation

#010852

Great Expressions Dental Centers

400 Carillon Parkway, Ste 120

St Petersburg, FL 33716

(727) 299-0728

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN22099 Alter, Jason

NPI: 1750734703 LIC: DN22099

CERTIFICATIONS :

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN18737 Luce, Amy

NPI: 1770888059 LIC: DN18737

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN15142 Reed, Samantha

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 234 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1104042456 LIC: DN15142

CERTIFICATIONS :

• Inhalation Sedation

# DN24093 Vanman, Jason

NPI: 1245898154 LIC: DN24093

CERTIFICATIONS :

# DN19801 Wheeley, Amrita

NPI: 1649533605 LIC: DN19801

CERTIFICATIONS :

#010982

Great Expressions Dental Centers

2938 West Bay Drive Ste C

Belleair Bluffs, FL 33770

(727) 584-5548

Special Needs: No

English

M 10am - 7pm, T 8am - 5pm

F 7am-4pm

# DN22728 Franz, Rachel

NPI: 1881114825 LIC: DN22728

CERTIFICATIONS :

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN19801 Wheeley, Amrita

NPI: 1649533605 LIC: DN19801

CERTIFICATIONS :

#010998

Great Expressions Dental Centers

11701 Belcher Road South, Ste #103

Largo, FL 33773

(727) 531-7676

Special Needs: Yes

English, Spanish

M-T 10am-7pm

W-F 7am-4pm

# DN24345 Baez, Dayron

NPI: 1578125431 LIC: DN24345

CERTIFICATIONS :

# DN13315 Rodenbostel, Peter

NPI: 1790822930 LIC: DN13315

CERTIFICATIONS :

#011004

Great Expressions Dental Centers

35176 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 723-1400

Special Needs: No

English

M-T 8am-5pm

W-F 8am-5pm

# DN22775 Bala, Joanna

NPI: 1144743774 LIC: DN22775

CERTIFICATIONS :

# DN13315 Rodenbostel, Peter

NPI: 1790822930 LIC: DN13315

CERTIFICATIONS :

# DN19801 Wheeley, Amrita

NPI: 1649533605 LIC: DN19801

CERTIFICATIONS :

#011005

Great Expressions Dental Centers

6759 First Ave South

St Petersburg, FL 33707

(727) 381-1642

Special Needs: No

English

M-T 8am-5pm

W-F 8am-5pm

# DN13315 Rodenbostel, Peter

NPI: 1790822930 LIC: DN13315

CERTIFICATIONS :

#011006

Great Expressions Dental Centers

5002 73Rd Ave North

Pinellas Park, FL 33781

(727) 544-7733

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17816 Magazine, Joanna

NPI: 1437346376 LIC: DN17816

CERTIFICATIONS :

#010954

Greenberg Dental & Orthodontics

36091 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 330-2765

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 8am - 4pm

W-F 7am-3pm

S 7am - 2pm

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark*

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew*

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory*

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd*

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy*

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul*

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine*

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

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 235 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin*

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#011425

Greenberg Dental & Orthodontics

10472 Roosevelt Blvd North

Saint Petersburg, FL 33716

(727) 399-6938

Special Needs: Yes

English, Spanish, Albanian (T), Tamil

M-T 7am-3pm

W 11am-7pm, Th 8am-4pm,F

7am-3pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#012474

Greenberg Dental & Orthodontics

2045 Gulf To Bay Blvd Ste B

Clearwater, FL 33765

(727) 474-0211

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

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 236 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22803 Patel, Devesh

NPI: 1306367420 LIC: DN22803

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#013935

Greenberg Dental & Orthodontics

3711 49Th St North

Saint Petersburg, FL 33710

(727) 547-3603

Special Needs: No

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

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 237 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#012053

Greenberg Dental & Orthodontics

2950 34Th St.

Saint Petersburg, FL 33711

(727) 547-3603

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

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 238 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

CERTIFICATIONS :

#017047

Greenberg Dental & Orthodontics,

12963 Walsingham Road

Largo, FL 33774

(727) 265-3307

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 11am-7pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

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

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 239 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

# 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 :

ENDODONTICS

#010954

Greenberg Dental & Orthodontics

36091 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 330-2765

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 8am - 4pm

W-F 7am-3pm

S 7am - 2pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#011425

Greenberg Dental & Orthodontics

10472 Roosevelt Blvd North

Saint Petersburg, FL 33716

(727) 399-6938

Special Needs: Yes

English, Spanish, Albanian (T), Tamil

M-T 7am-3pm

W 11am-7pm, Th 8am-4pm,F

7am-3pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#012474

Greenberg Dental & Orthodontics

2045 Gulf To Bay Blvd Ste B

Clearwater, FL 33765

(727) 474-0211

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#013935

Greenberg Dental & Orthodontics

3711 49Th St North

Saint Petersburg, FL 33710

(727) 547-3603

Special Needs: No

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#012053

Greenberg Dental & Orthodontics

2950 34Th St.

Saint Petersburg, FL 33711

(727) 547-3603

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#017047

Greenberg Dental & Orthodontics,

12963 Walsingham Road

Largo, FL 33774

(727) 265-3307

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 11am-7pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

#011546

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 240 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN13421 Gittess, Robert

NPI: 1922137058 LIC: DN13421

CERTIFICATIONS :

ORAL SURGEON

#010954

Greenberg Dental & Orthodontics

36091 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 330-2765

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 8am - 4pm

W-F 7am-3pm

S 7am - 2pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#012474

Greenberg Dental & Orthodontics

2045 Gulf To Bay Blvd Ste B

Clearwater, FL 33765

(727) 474-0211

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#013935

Greenberg Dental & Orthodontics

3711 49Th St North

Saint Petersburg, FL 33710

(727) 547-3603

Special Needs: No

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#012053

Greenberg Dental & Orthodontics

2950 34Th St.

Saint Petersburg, FL 33711

(727) 547-3603

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#022289

Countryside Mall Dental PA

27001 Us Highway 19 N, Ste 1031B

Clearwater, FL 33761

(727) 669-1600

Special Needs: Yes

English, Russian, Spanish

M-T 10am-9pm

W-F 10am-9pm

S 10am - 9pm, Su 11am - 6pm

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#014674

Florida Orthodontic Associates

8686 131St Street N

Seminole, FL 33776

www.floridaorthodontics.com

(727) 205-0036

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23098 Angeloni, Mark

NPI: 1881047843 LIC: DN23098

CERTIFICATIONS :

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#022669

Florida Orthodontic Associates

PLLC

35036 Us Highway 19

Palm Harbor, FL 34684

(727) 446-4699

Special Needs: No

English

M-T 8am-5pm

W-F 8am-5pm

# DN23098 Angeloni, Mark

NPI: 1881047843 LIC: DN23098

CERTIFICATIONS :

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#011220

Florida Orthodontic Associates,

LLC

1433 Court St

Clearwater, FL 33756

(727) 205-1643

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23098 Angeloni, Mark

NPI: 1881047843 LIC: DN23098

CERTIFICATIONS :

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#011221

Florida Orthodontic Associates,

LLC

5885 Central Ave

Saint Petersburg, FL 33710

(727) 205-0036

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23098 Angeloni, Mark

NPI: 1881047843 LIC: DN23098

CERTIFICATIONS :

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#010954

Greenberg Dental & Orthodontics

36091 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 330-2765

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 8am - 4pm

W-F 7am-3pm

S 7am - 2pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#011425

Greenberg Dental & Orthodontics

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 241 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

10472 Roosevelt Blvd North

Saint Petersburg, FL 33716

(727) 399-6938

Special Needs: Yes

English, Spanish, Albanian (T), Tamil

M-T 7am-3pm

W 11am-7pm, Th 8am-4pm,F

7am-3pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#012474

Greenberg Dental & Orthodontics

2045 Gulf To Bay Blvd Ste B

Clearwater, FL 33765

(727) 474-0211

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN20464 Guloy, Robertzon

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#013935

Greenberg Dental & Orthodontics

3711 49Th St North

Saint Petersburg, FL 33710

(727) 547-3603

Special Needs: No

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN20464 Guloy, Robertzon

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#012053

Greenberg Dental & Orthodontics

2950 34Th St.

Saint Petersburg, FL 33711

(727) 547-3603

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

CERTIFICATIONS :

#014773

Mann Orthodontics, PA

6026 Park Blvd

Pinellas Park, FL 33781

www.mannmadesmiles.com

(727) 392-7734

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN20141 Mann, Nicholas

NPI: 1508205139 LIC: DN20141

CERTIFICATIONS :

#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

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#021708

Children and Teen Dental Group

of Florida

2707 Tampa Road

Palm Harbor, FL 34684

(727) 785-6521

Special Needs: Yes

English, Spanish, Portuguese

M-T 8am-5pm

W-F 8am-5pm

# DN12365 Montgomery, Nancy

NPI: 1538200282 LIC: DN12365

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#022289

Countryside Mall Dental PA

27001 Us Highway 19 N, Ste 1031B

Clearwater, FL 33761

(727) 669-1600

Special Needs: Yes

English, Russian, Spanish

M-T 10am-9pm

W-F 10am-9pm

S 10am - 9pm, Su 11am - 6pm

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#016106

Florida Pediatric Dental Associates

1433 Court St

Clearwater, FL 33756

(727) 442-6098

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13950 Blankenship, Susan

NPI: 1679699383 LIC: DN13950

CERTIFICATIONS :

• Inhalation Sedation

# DN23234 Cummings, Marloin

NPI: 1467545087 LIC: DN23234

CERTIFICATIONS :

# DN24376 McNair, Jonathan

NPI: 1841642154 LIC: DN24376

CERTIFICATIONS :

# DN14677 Vales, Ana-Marai

NPI: 1215146493 LIC: DN14677

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#016107

Florida Pediatric Dental Associates

8686 131St St. N

Seminole, FL 33776

(727) 205-0036

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13950 Blankenship, Susan

NPI: 1679699383 LIC: DN13950

CERTIFICATIONS :

• Inhalation Sedation

# DN23234 Cummings, Marloin

NPI: 1467545087 LIC: DN23234

CERTIFICATIONS :

# DN24376 McNair, Jonathan

NPI: 1841642154 LIC: DN24376

CERTIFICATIONS :

# DN14677 Vales, Ana-Marai

NPI: 1215146493 LIC: DN14677

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#022803

Florida Pediatric Dental Associates

PLLC

5885 Central Ave, Ste B

Saint Petersburg, FL 33710

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 242 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(727) 325-6485

Special Needs: No

M-T 8am-5pm

W-F 8am-5pm

# DN23234 Cummings, Marloin

NPI: 1467545087 LIC: DN23234

CERTIFICATIONS :

# DN24376 McNair, Jonathan

NPI: 1841642154 LIC: DN24376

CERTIFICATIONS :

#010852

Great Expressions Dental Centers

400 Carillon Parkway, Ste 120

St Petersburg, FL 33716

(727) 299-0728

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN24084 Cataldo, Dorothy

NPI: 1053849232 LIC: DN24084

CERTIFICATIONS :

# DN18658 Rosen, David

NPI: 1093944274 LIC: DN18658

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010954

Greenberg Dental & Orthodontics

36091 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 330-2765

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 8am - 4pm

W-F 7am-3pm

S 7am - 2pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#011425

Greenberg Dental & Orthodontics

10472 Roosevelt Blvd North

Saint Petersburg, FL 33716

(727) 399-6938

Special Needs: Yes

English, Spanish, Albanian (T), Tamil

M-T 7am-3pm

W 11am-7pm, Th 8am-4pm,F

7am-3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#012474

Greenberg Dental & Orthodontics

2045 Gulf To Bay Blvd Ste B

Clearwater, FL 33765

(727) 474-0211

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#013935

Greenberg Dental & Orthodontics

3711 49Th St North

Saint Petersburg, FL 33710

(727) 547-3603

Special Needs: No

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#012053

Greenberg Dental & Orthodontics

2950 34Th St.

Saint Petersburg, FL 33711

(727) 547-3603

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

#017047

Greenberg Dental & Orthodontics,

12963 Walsingham Road

Largo, FL 33774

(727) 265-3307

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 11am-7pm

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

#020350

Harp Family Dentistry

31067 Us Highway 19N

Palm Harbor, FL 34684

(727) 304-5483

Special Needs: Yes

English

M-T 8am-5pm

W-Th 8am-5pm

# DN22474 Dawoud, Mark

NPI: 1013277037 LIC: DN22474

CERTIFICATIONS :

• Inhalation Sedation

#018401

Kids Smiles Dental, PLLC

5885 Central Ave

Saint Petersburg, FL 33710

(813) 968-2483

Special Needs: Yes

English, Spanish

M 7am - 5pm,

W 7am-5pm,

# DN21519 Kwon, Mia

NPI: 1093198160 LIC: DN21519

CERTIFICATIONS :

• Inhalation Sedation

# DN23158 Navarro, Jose

NPI: 1366883548 LIC: DN23158

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 243 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN13285 Sierra, Frank

NPI: 1215040373 LIC: DN13285

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

#011379

Richard W. Blake, DDS, PA

2701 Park Drive, Ste 1

Clearwater, FL 33763

(727) 796-2187

Special Needs: Yes

English, Spanish

T 7am - 3pm

W-F 7am-3pm

# DN5634 Blake, Richard

NPI: 1912921867 LIC: DN5634

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#013980

Smile Design

4300 4Th St N

Saint Petersburg, FL 33703

(727) 526-7500

Special Needs: Yes

English

M-T 8am-4pm

W-F 8am-4pm

# DN21646 Theogene, Dorothy*

NPI: 1699055004 LIC: DN21646

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

#010946

Susan D. Blankenship, DMD

35036 Us Highway 19 N

Palm Harbor, FL 34684

(727) 446-4699

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN13950 Blankenship, Susan

NPI: 1679699383 LIC: DN13950

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

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

#010954

Greenberg Dental & Orthodontics

36091 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 330-2765

Special Needs: Yes

English, Spanish

M 7am - 3pm, T 8am - 4pm

W-F 7am-3pm

S 7am - 2pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#011425

Greenberg Dental & Orthodontics

10472 Roosevelt Blvd North

Saint Petersburg, FL 33716

(727) 399-6938

Special Needs: Yes

English, Spanish, Albanian (T), Tamil

M-T 7am-3pm

W 11am-7pm, Th 8am-4pm,F

7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#012474

Greenberg Dental & Orthodontics

2045 Gulf To Bay Blvd Ste B

Clearwater, FL 33765

(727) 474-0211

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#013935

Greenberg Dental & Orthodontics

3711 49Th St North

Saint Petersburg, FL 33710

(727) 547-3603

Special Needs: No

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#012053

Greenberg Dental & Orthodontics

2950 34Th St.

Saint Petersburg, FL 33711

(727) 547-3603

Special Needs: Yes

English, Spanish

M-T 11am-7pm

W-F 7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

#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

# DN13591 Nielsen, Pamela

NPI: 1124118245 LIC: DN13591

CERTIFICATIONS :

PROSTHODONTICS

#010852

Great Expressions Dental Centers

400 Carillon Parkway, Ste 120

St Petersburg, FL 33716

(727) 299-0728

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN22473 Dinse, William

NPI: 1487645164 LIC: DN22473

CERTIFICATIONS :

#011004

Great Expressions Dental Centers

35176 Us Hwy 19 North

Palm Harbor, FL 34684

(727) 723-1400

Special Needs: No

English

M-T 8am-5pm

W-F 8am-5pm

# DN22473 Dinse, William

NPI: 1487645164 LIC: DN22473

CERTIFICATIONS :

POLK COUNTY

DENTIST

#CHC7919

Central Florida Health Care

109 W. Wall St

Frostproof, FL 33843

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 244 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(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

# DN22773 Aiyede, Onize

NPI: 1306295712 LIC: DN22773

CERTIFICATIONS :

# HAD80 Antony, Archana

NPI: 1851607766 LIC: HAD80

CERTIFICATIONS :

# DN23944 Batista, Claudia

NPI: 1447747449 LIC: DN23944

CERTIFICATIONS :

# DN12871 Cardenas, Carlos

NPI: 1568649804 LIC: DN12871

CERTIFICATIONS :

# HAD92 Coello, Marla

NPI: 1891833620 LIC: HAD92

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 :

#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

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 245 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

# 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 :

#021547

Charles D. Llano, DDS

320 W Highland Drive

Lakeland, FL 33813

(863) 644-2428

Special Needs: No

English

M-T 8am-5pm

W-Th 8am-5pm

# DN6425 Llano, Charles*

NPI: 1093820995 LIC: DN6425

CERTIFICATIONS :

#014183

Children and Teen Dental Group

of Florida

225 Imperial Blvd

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 246 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Lakeland, FL 33803

(863) 644-4739

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN16260 Adewunmi, Mopelola

NPI: 1477605053 LIC: DN16260

CERTIFICATIONS :

• Inhalation Sedation

# DN20260 Chang, Steven

NPI: 1649611799 LIC: DN20260

CERTIFICATIONS :

• Inhalation Sedation

# DN19041 Chapagain, Shweta

NPI: 1346561396 LIC: DN19041

CERTIFICATIONS :

• Inhalation Sedation

# DN23038 Hernandez, Christine

NPI: 1891216784 LIC: DN23038

CERTIFICATIONS :

• Inhalation Sedation

# DN21215 Martinez, Zunith

NPI: 1487035085 LIC: DN21215

CERTIFICATIONS :

• Inhalation Sedation

# DN21454 Raju, Stevy

NPI: 1891163143 LIC: DN21454

CERTIFICATIONS :

• Inhalation Sedation

# DN22093 St Charles II, Jay

NPI: 1336591452 LIC: DN22093

CERTIFICATIONS :

• Inhalation Sedation

#022557

Children and Teen Dental Group

of Florida

727 3Rd Street Sw

Winter Haven, FL 33880

(863) 644-4739

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN16260 Adewunmi, Mopelola

NPI: 1477605053 LIC: DN16260

CERTIFICATIONS :

• Inhalation Sedation

# DN20260 Chang, Steven

NPI: 1649611799 LIC: DN20260

CERTIFICATIONS :

• Inhalation Sedation

# DN19041 Chapagain, Shweta

NPI: 1346561396 LIC: DN19041

CERTIFICATIONS :

• Inhalation Sedation

# DN21215 Martinez, Zunith

NPI: 1487035085 LIC: DN21215

CERTIFICATIONS :

• Inhalation Sedation

# DN21454 Raju, Stevy

NPI: 1891163143 LIC: DN21454

CERTIFICATIONS :

• Inhalation Sedation

# DN22093 St Charles II, Jay

NPI: 1336591452 LIC: DN22093

CERTIFICATIONS :

• Inhalation Sedation

#012845

Dental Associates of Bartow

2090 Flamingo Drive East

Bartow, FL 33830

(863) 614-1801

Special Needs: Yes

English

T 8am - 4pm

W-Th 8am-4pm

# DN12624 Di Re, Anthony

NPI: 1487764528 LIC: DN12624

CERTIFICATIONS :

# DN18265 Fenton, Chelsea

NPI: 1881842615 LIC: DN18265

CERTIFICATIONS :

• Inhalation Sedation

# DN17074 Mueller, William

NPI: 1164574679 LIC: DN17074

CERTIFICATIONS :

# DN14392 Walding III, Stephen

NPI: 1023160637 LIC: DN14392

CERTIFICATIONS :

#010978

Dental Associates of Florida

(South Lakeland) PLLC

444 W Pipkin Rd

Lakeland, FL 33813

(863) 619-6600

Special Needs: Yes

English, Spanish

M-T 7am-5pm

W 7am-3pm, Th 7am-5pm

# DN12624 Di Re, Anthony

NPI: 1487764528 LIC: DN12624

CERTIFICATIONS :

# DN23472 Kruja, Tauland

NPI: 1174017784 LIC: DN23472

CERTIFICATIONS :

# DN22280 Leung, Melanie

NPI: 1407265010 LIC: DN22280

CERTIFICATIONS :

• Inhalation Sedation

# DN17074 Mueller, William

NPI: 1164574679 LIC: DN17074

CERTIFICATIONS :

# DN14392 Walding III, Stephen

NPI: 1023160637 LIC: DN14392

CERTIFICATIONS :

#014657

Dental View

814 Spring Lake Square

Winter Haven, FL 33881

http://www.mydentalview.com

(863) 268-2300

Special Needs: Yes

English, Spanish, Polish

M 11am - 7pm, T 8am - 4pm

W-Th 8am-4pm

# DN20766 Reyes, Monika

NPI: 1316353311 LIC: DN20766

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

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

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 247 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

#015103

Greenberg Dental - Poinciana

1096 Cypress Pkwy

Kissimmee, FL 34759

(407) 933-8222

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

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 248 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#014212

Greenberg Dental & Orthodontics

4969 Us Hwy 98 N

Lakeland, FL 33809

(863) 614-0044

Special Needs: Yes

English, Spanish, Tagalog

M 7am - 6pm, T 8am - 6pm

Th-F 7am-3pm

S 7am - 1pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23434 Chohan, Sumera

NPI: 1922592609 LIC: DN23434

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

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 249 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22832 Letteri, Nicholas*

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#016183

Greenberg Dental & Orthodontics

2926 S. Florida Ave

Lakeland, FL 33803

(863) 226-6269

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23434 Chohan, Sumera

NPI: 1922592609 LIC: DN23434

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

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 250 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN23449 Kermani, Aida

NPI: 1649763830 LIC: DN23449

CERTIFICATIONS :

• Inhalation Sedation

# DN22832 Letteri, Nicholas*

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#019423

Greenberg Dental & Orthodontics

42613 Highway 27

Davenport, FL 33837

(863) 824-7098

Special Needs: No

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

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 251 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#020828

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 252 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Greenberg Dental & Orthodontics

7070 Cypress Gardens Blvd

Winter Haven, FL 33884

(863) 259-4026

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23434 Chohan, Sumera

NPI: 1922592609 LIC: DN23434

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN22704 Foreman, Kathleen

NPI: 1407377724 LIC: DN22704

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22803 Patel, Devesh

NPI: 1306367420 LIC: DN22803

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN22428 Salehi, Shiva

NPI: 1346696549 LIC: DN22428

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

#012373

Greenberg Dental & Orthodontics,

1475 6Th St Nw

Winter Haven, FL 33881

(863) 226-0261

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 1pm

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

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 253 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#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 :

#007662

Philip Contreras

1251 Ariana Street

Lakeland, FL 33803

(863) 688-9884

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN14550 Contreras, Philip

NPI: 1508950510 LIC: DN14550

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 :

#019440

Smile Care Center

103 S Dixie Dr

Haines City, FL 33844

(863) 547-9699

Special Needs: No

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN16966 Gaitan, German

NPI: 1164543351 LIC: DN16966

CERTIFICATIONS :

ENDODONTICS

#015103

Greenberg Dental - Poinciana

1096 Cypress Pkwy

Kissimmee, FL 34759

(407) 933-8222

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#014212

Greenberg Dental & Orthodontics

4969 Us Hwy 98 N

Lakeland, FL 33809

(863) 614-0044

Special Needs: Yes

English, Spanish, Tagalog

M 7am - 6pm, T 8am - 6pm

Th-F 7am-3pm

S 7am - 1pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

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 254 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#016183

Greenberg Dental & Orthodontics

2926 S. Florida Ave

Lakeland, FL 33803

(863) 226-6269

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#019423

Greenberg Dental & Orthodontics

42613 Highway 27

Davenport, FL 33837

(863) 824-7098

Special Needs: No

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

# DN19321 Bienias, Russell

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#020828

Greenberg Dental & Orthodontics

7070 Cypress Gardens Blvd

Winter Haven, FL 33884

(863) 259-4026

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#012373

Greenberg Dental & Orthodontics,

1475 6Th St Nw

Winter Haven, FL 33881

(863) 226-0261

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 1pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

ORAL SURGEON

#015103

Greenberg Dental - Poinciana

1096 Cypress Pkwy

Kissimmee, FL 34759

(407) 933-8222

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#014212

Greenberg Dental & Orthodontics

4969 Us Hwy 98 N

Lakeland, FL 33809

(863) 614-0044

Special Needs: Yes

English, Spanish, Tagalog

M 7am - 6pm, T 8am - 6pm

Th-F 7am-3pm

S 7am - 1pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

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 255 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#016183

Greenberg Dental & Orthodontics

2926 S. Florida Ave

Lakeland, FL 33803

(863) 226-6269

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#019423

Greenberg Dental & Orthodontics

42613 Highway 27

Davenport, FL 33837

(863) 824-7098

Special Needs: No

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

# DN19573 Adams, Bryan

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#012373

Greenberg Dental & Orthodontics,

1475 6Th St Nw

Winter Haven, FL 33881

(863) 226-0261

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 1pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#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

ORTHODONTIST

#015103

Greenberg Dental - Poinciana

1096 Cypress Pkwy

Kissimmee, FL 34759

(407) 933-8222

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#014212

Greenberg Dental & Orthodontics

4969 Us Hwy 98 N

Lakeland, FL 33809

(863) 614-0044

Special Needs: Yes

English, Spanish, Tagalog

M 7am - 6pm, T 8am - 6pm

Th-F 7am-3pm

S 7am - 1pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

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 256 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

#016183

Greenberg Dental & Orthodontics

2926 S. Florida Ave

Lakeland, FL 33803

(863) 226-6269

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

#012373

Greenberg Dental & Orthodontics,

1475 6Th St Nw

Winter Haven, FL 33881

(863) 226-0261

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 1pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#021597

Scott Orthodontic Associates

5110 South Lakeland Drive

Lakeland, FL 33813

(863) 709-1941

Special Needs: No

English

M-T 8am-5pm

W-Th 8am-5pm

# DN0011202 Scott, Gregory*

NPI: 1063632214 LIC: DN0011202

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#014183

Children and Teen Dental Group

of Florida

225 Imperial Blvd

Lakeland, FL 33803

(863) 644-4739

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN24678 Latham, Thao

NPI: 1598171555 LIC: DN24678

CERTIFICATIONS :

# DN12365 Montgomery, Nancy

NPI: 1538200282 LIC: DN12365

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#022557

Children and Teen Dental Group

of Florida

727 3Rd Street Sw

Winter Haven, FL 33880

(863) 644-4739

Special Needs: Yes

English

M-T 8am-5pm

W-F 8am-5pm

# DN12365 Montgomery, Nancy

NPI: 1538200282 LIC: DN12365

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#023122

Children and Teen Dental Group

of Florida

2015 E. Edgewood Drive

Lakeland, FL 33803

(863) 667-9000

Special Needs: Yes

English

M-T 7am-5pm

W-Th 7am-5pm

# DN12365 Montgomery, Nancy

NPI: 1538200282 LIC: DN12365

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#015103

Greenberg Dental - Poinciana

1096 Cypress Pkwy

Kissimmee, FL 34759

(407) 933-8222

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

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 257 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#014212

Greenberg Dental & Orthodontics

4969 Us Hwy 98 N

Lakeland, FL 33809

(863) 614-0044

Special Needs: Yes

English, Spanish, Tagalog

M 7am - 6pm, T 8am - 6pm

Th-F 7am-3pm

S 7am - 1pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#016183

Greenberg Dental & Orthodontics

2926 S. Florida Ave

Lakeland, FL 33803

(863) 226-6269

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#019423

Greenberg Dental & Orthodontics

42613 Highway 27

Davenport, FL 33837

(863) 824-7098

Special Needs: No

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#020828

Greenberg Dental & Orthodontics

7070 Cypress Gardens Blvd

Winter Haven, FL 33884

(863) 259-4026

Special Needs: Yes

English, Spanish

M-T 8am-4pm

W-Th 10am-6pm

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

#012373

Greenberg Dental & Orthodontics,

1475 6Th St Nw

Winter Haven, FL 33881

(863) 226-0261

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 1pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

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 258 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

PERIODONTICS

#015103

Greenberg Dental - Poinciana

1096 Cypress Pkwy

Kissimmee, FL 34759

(407) 933-8222

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#014212

Greenberg Dental & Orthodontics

4969 Us Hwy 98 N

Lakeland, FL 33809

(863) 614-0044

Special Needs: Yes

English, Spanish, Tagalog

M 7am - 6pm, T 8am - 6pm

Th-F 7am-3pm

S 7am - 1pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#016183

Greenberg Dental & Orthodontics

2926 S. Florida Ave

Lakeland, FL 33803

(863) 226-6269

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN15277 Cherry, Elizabeth*

NPI: 1952361388 LIC: DN15277

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#019423

Greenberg Dental & Orthodontics

42613 Highway 27

Davenport, FL 33837

(863) 824-7098

Special Needs: No

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#012373

Greenberg Dental & Orthodontics,

1475 6Th St Nw

Winter Haven, FL 33881

(863) 226-0261

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 1pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

PROSTHODONTICS

#015103

Greenberg Dental - Poinciana

1096 Cypress Pkwy

Kissimmee, FL 34759

(407) 933-8222

Special Needs: Yes

Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#014212

Greenberg Dental & Orthodontics

4969 Us Hwy 98 N

Lakeland, FL 33809

(863) 614-0044

Special Needs: Yes

English, Spanish, Tagalog

M 7am - 6pm, T 8am - 6pm

Th-F 7am-3pm

S 7am - 1pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#016183

Greenberg Dental & Orthodontics

2926 S. Florida Ave

Lakeland, FL 33803

(863) 226-6269

Special Needs: No

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#019423

Greenberg Dental & Orthodontics

42613 Highway 27

Davenport, FL 33837

(863) 824-7098

Special Needs: No

English, Spanish

M 10am - 6pm, T 7am - 3pm

W 7am-3pm, Th 10am-6pm,F

7am-3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#012373

Greenberg Dental & Orthodontics,

1475 6Th St Nw

Winter Haven, FL 33881

(863) 226-0261

Special Needs: Yes

English, Spanish

M-T 7am-7pm

W-Th 7am-7pm

S 7am - 1pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

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

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 259 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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

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 :

#CHC015415

DOH - Saint Johns County Health

Department

200 San Sebastian View

Saint Augustine, FL 32084

(904) 209-3250

Special Needs: No

English, Spanish, Sign Languages

M-T 8am-5pm

W-F 8am-5pm

# DN16834 Robledo, Concepcion

NPI: 1932134392 LIC: DN16834

CERTIFICATIONS :

#011007

Great Expressions Dental Centers

238 Solana Road

Ponte Vedra Beach, FL 32082

(904) 280-1717

Special Needs: Yes

English, Spanish, Polish

M-T 7am-4pm

W-Th 7am-4pm

# DN11948 Clark, Patricia

NPI: 1871677476 LIC: DN11948

CERTIFICATIONS :

# DN19493 De Loach, Melanie*

NPI: 1053690222 LIC: DN19493

CERTIFICATIONS :

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#011012

Great Expressions Dental Centers

9 St. Johnson Medical Park, Ste B

Saint Augustine, FL 32086

(904) 797-4108

Special Needs: Yes

English, Spanish, French

M-T 8am-5pm

W-F 8am-5pm

# DN14408 Gosselin, Pierre

NPI: 1033265426 LIC: DN14408

CERTIFICATIONS :

# DN7977 Woodward, Wyman

NPI: 1932255320 LIC: DN7977

CERTIFICATIONS :

#015125

Greenberg Dental - Fruit Cove

540 State Rd 13 North, Ste 101

Fruit Cove, FL 32259

(904) 217-4019

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

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 260 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

#017795

Greenberg Dental & Orthodontics

PA-St. Augustine

240 State Rd 312

Saint Augustine, FL 32086

(904) 429-3558

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

Th-F 7am-3pm

S 8am - 2pm

# DN19360 Acevedo-Decandis,

Stephanie

NPI: 1962797498 LIC: DN19360

CERTIFICATIONS :

• Inhalation Sedation

# DN23698 Asadi, Siraj

NPI: 1235612730 LIC: DN23698

CERTIFICATIONS :

# DN21311 Barbela, Antal

NPI: 1508247313 LIC: DN21311

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN20398 Burgess Chaves,

Stephanie

NPI: 1144655143 LIC: DN20398

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN21460 Garcia, Emily

NPI: 1932584745 LIC: DN21460

CERTIFICATIONS :

• Inhalation Sedation

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN23406 Gregory, Allison

NPI: 1518459437 LIC: DN23406

CERTIFICATIONS :

# DN19365 Hasona, Adnan

NPI: 1881980928 LIC: DN19365

CERTIFICATIONS :

# DN23359 Houston, Kyle

NPI: 1841784238 LIC: DN23359

CERTIFICATIONS :

# DN22205 Lidhran, Paraminderpal

NPI: 1609322270 LIC: DN22205

CERTIFICATIONS :

# DN22097 Mabardi, Nicolas

NPI: 1093168510 LIC: DN22097

CERTIFICATIONS :

# DN24268 Parker, Ryan

NPI: 1255991972 LIC: DN24268

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN18785 Patel, Viral

NPI: 1881917540 LIC: DN18785

CERTIFICATIONS :

• Inhalation Sedation

# DN21362 Poblenz, Charles

NPI: 1134501141 LIC: DN21362

CERTIFICATIONS :

# DN22077 Soni, Juhi

NPI: 1821441379 LIC: DN22077

CERTIFICATIONS :

# DN23589 Starkey, Jenna

NPI: 1346736352 LIC: DN23589

CERTIFICATIONS :

# DN24117 Valiente, Esteban

NPI: 1144889494 LIC: DN24117

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN20877 Zariffard, Ehsan

NPI: 1528458932 LIC: DN20877

CERTIFICATIONS :

• Inhalation Sedation

ENDODONTICS

#011012

Great Expressions Dental Centers

9 St. Johnson Medical Park, Ste B

Saint Augustine, FL 32086

(904) 797-4108

Special Needs: Yes

English, Spanish, French

M-T 8am-5pm

W-F 8am-5pm

# DN19093 Douglas, Bethany

NPI: 1437484128 LIC: DN19093

CERTIFICATIONS :

# DN19363 Serrano, Eric

NPI: 1184919334 LIC: DN19363

CERTIFICATIONS :

#015125

Greenberg Dental - Fruit Cove

540 State Rd 13 North, Ste 101

Fruit Cove, FL 32259

(904) 217-4019

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

CERTIFICATIONS :

• Inhalation Sedation

# DN18368 Bennett, James

NPI: 1659587715 LIC: DN18368

CERTIFICATIONS :

# DN22756 Chung, Ada

NPI: 1801300942 LIC: DN22756

CERTIFICATIONS :

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

#017795

Greenberg Dental & Orthodontics

PA-St. Augustine

240 State Rd 312

Saint Augustine, FL 32086

(904) 429-3558

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

Th-F 7am-3pm

S 8am - 2pm

# DN19067 Antony, Kathryn

NPI: 1811209059 LIC: DN19067

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 261 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN23603 Doshi, Rajvi

NPI: 1861979486 LIC: DN23603

CERTIFICATIONS :

# DN22048 Dubey, Akhil

NPI: 1982057444 LIC: DN22048

CERTIFICATIONS :

# DN23282 Isaza, Sebastian

NPI: 1659892743 LIC: DN23282

CERTIFICATIONS :

# DN23928 Lee, Ava

NPI: 1255833224 LIC: DN23928

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN23386 Park, Chin

NPI: 1063904449 LIC: DN23386

CERTIFICATIONS :

# DN24222 Shano, Ammar

NPI: 1629637871 LIC: DN24222

CERTIFICATIONS :

# DN21922 Six, Denise

NPI: 1104277722 LIC: DN21922

CERTIFICATIONS :

# DN23403 Veazey, Sarah

NPI: 1841783222 LIC: DN23403

CERTIFICATIONS :

• Inhalation Sedation

ORAL SURGEON

#015125

Greenberg Dental - Fruit Cove

540 State Rd 13 North, Ste 101

Fruit Cove, FL 32259

(904) 217-4019

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason*

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

#017795

Greenberg Dental & Orthodontics

PA-St. Augustine

240 State Rd 312

Saint Augustine, FL 32086

(904) 429-3558

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

Th-F 7am-3pm

S 8am - 2pm

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN18554 Lee, Jason

NPI: 1578622908 LIC: DN18554

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#015125

Greenberg Dental - Fruit Cove

540 State Rd 13 North, Ste 101

Fruit Cove, FL 32259

(904) 217-4019

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN18750 Bouvier, Amy*

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang*

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce*

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia*

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan*

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

#017795

Greenberg Dental & Orthodontics

PA-St. Augustine

240 State Rd 312

Saint Augustine, FL 32086

(904) 429-3558

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

Th-F 7am-3pm

S 8am - 2pm

# DN18750 Bouvier, Amy

NPI: 1447591789 LIC: DN18750

CERTIFICATIONS :

# DN18789 Cao, Trang

NPI: 1689803322 LIC: DN18789

CERTIFICATIONS :

• Board Certification

# DN20851 Gabler, Bryce

NPI: 1235551458 LIC: DN20851

CERTIFICATIONS :

# DN21116 Lipkin, Julia

NPI: 1225447493 LIC: DN21116

CERTIFICATIONS :

# DN17052 Long, Ryan

NPI: 1912077546 LIC: DN17052

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#015125

Greenberg Dental - Fruit Cove

540 State Rd 13 North, Ste 101

Fruit Cove, FL 32259

(904) 217-4019

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#017795

Greenberg Dental & Orthodontics

PA-St. Augustine

240 State Rd 312

Saint Augustine, FL 32086

(904) 429-3558

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

Th-F 7am-3pm

S 8am - 2pm

# DN15103 Bennett, James

NPI: 1902216153 LIC: DN15103

CERTIFICATIONS :

# DN20583 Gabler, Heather

NPI: 1588919724 LIC: DN20583

CERTIFICATIONS :

• Inhalation Sedation

#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

PERIODONTICS

#015125

Greenberg Dental - Fruit Cove

540 State Rd 13 North, Ste 101

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 262 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Fruit Cove, FL 32259

(904) 217-4019

Special Needs: Yes

English, Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

#017795

Greenberg Dental & Orthodontics

PA-St. Augustine

240 State Rd 312

Saint Augustine, FL 32086

(904) 429-3558

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 7am - 3pm

Th-F 7am-3pm

S 8am - 2pm

# DN16276 Barzyk, Jeffrey

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious 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 :

#CHC015267

DOH - Saint Lucie County Health

Department

537 Nw Lake Whitney Place, Ste 101

Port Saint Lucie, FL 34986

(772) 462-3800

Special Needs: No

English, Spanish, Creoles and Pidgins

(other), French

M-T 8am-5pm

W-Th 8am-5pm

S 8am - 2pm

# DN14245 Ahmad, Haleemah

NPI: 1437240835 LIC: DN14245

CERTIFICATIONS :

# HAD102 McKenzie, JaVon

NPI: 1073513172 LIC: HAD102

CERTIFICATIONS :

# DN9911 Singh, Rajinder

NPI: 1154527208 LIC: DN9911

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 :

#010866

Great Expressions Dental Centers

7554 S. Us Highway 1, Ste 13

Port Saint Lucie, FL 34952

(772) 343-1762

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 12pm

# DN18775 Luba, Kevin

NPI: 1801040399 LIC: DN18775

CERTIFICATIONS :

# DN22051 Sonchaiwanich, Keith

NPI: 1790137859 LIC: DN22051

CERTIFICATIONS :

# DN23412 Vuong, Wei Yin

NPI: 1639662174 LIC: DN23412

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

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 263 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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

PEDIATRIC DENTISTRY

#010866

Great Expressions Dental Centers

7554 S. Us Highway 1, Ste 13

Port Saint Lucie, FL 34952

(772) 343-1762

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 12pm

# DN20688 Acheampong, Emmanuel

NPI: 1407122252 LIC: DN20688

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

#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

# DN23115 Mendoza, Juan

NPI: 1821326430 LIC: DN23115

CERTIFICATIONS :

• Inhalation Sedation

# DN11699 Simon, David

NPI: 1508303587 LIC: DN11699

CERTIFICATIONS :

• Oral / Enteral Sedation

SANTA ROSA COUNTY

ORTHODONTIST

#019094

Fishbein Orthodontics

4875 Us 90

Pace, FL 32571

(850) 910-4850

Special Needs: Yes

English

M 8am - 5pm,

W-Th 8am-5pm

# DN22677 De Moya, Adrian

NPI: 1790259372 LIC: DN22677

CERTIFICATIONS :

# DN18812 Fishbein, Benjamin

NPI: 1144543620 LIC: DN18812

CERTIFICATIONS :

# DN22495 Howle, Sarah

NPI: 1215477146 LIC: DN22495

CERTIFICATIONS :

# DN18855 Rezaie, Maryam

NPI: 1467781443 LIC: DN18855

CERTIFICATIONS :

#019095

Fishbein Orthodontics

7552 Navarre Pkwy Unit 57

Navarre, FL 32566

(850) 477-1089

Special Needs: Yes

English

T 8am - 5pm

# DN22677 De Moya, Adrian

NPI: 1790259372 LIC: DN22677

CERTIFICATIONS :

# DN18812 Fishbein, Benjamin

NPI: 1144543620 LIC: DN18812

CERTIFICATIONS :

# DN22495 Howle, Sarah

NPI: 1215477146 LIC: DN22495

CERTIFICATIONS :

# DN18855 Rezaie, Maryam

NPI: 1467781443 LIC: DN18855

CERTIFICATIONS :

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

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 :

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 264 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• 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 :

#016943

Great Expressions Dental Centers

5278 University Parkway

Sarasota, FL 34243

(941) 260-3394

Special Needs: Yes

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN22776 Maduro, Ledesha

NPI: 1174982458 LIC: DN22776

CERTIFICATIONS :

# DN22938 Sanchez, Diego

NPI: 1902329816 LIC: DN22938

CERTIFICATIONS :

# DN22138 Sandesara, Pooja

NPI: 1396108296 LIC: DN22138

CERTIFICATIONS :

• Inhalation Sedation

# DN22695 Toribio Fabelo, Leydy

NPI: 1033639554 LIC: DN22695

CERTIFICATIONS :

• Inhalation Sedation

#013934

Greenberg Dental & Orthodontics

4280 Bee Ridge Rd.

Sarasota, FL 34233

(941) 363-6381

Special Needs: Yes

English, Spanish

M-T 7am-6pm

W-Th 7am-6pm

S 7am - 2pm

# DN23486 Ackley, Andrea

NPI: 1417440637 LIC: DN23486

CERTIFICATIONS :

• Inhalation Sedation

# DN23476 Alberto, Andres

NPI: 1164915419 LIC: DN23476

CERTIFICATIONS :

# DN22130 Arditi, Sibel

NPI: 1821441445 LIC: DN22130

CERTIFICATIONS :

# DN22132 Bacchelli, Lara

NPI: 1740633718 LIC: DN22132

CERTIFICATIONS :

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23924 Castillo, Isabel

NPI: 1477962413 LIC: DN23924

CERTIFICATIONS :

# DN21327 Dockus, Matthew

NPI: 1013399013 LIC: DN21327

CERTIFICATIONS :

# DN23467 Folks, Garrett

NPI: 1437643137 LIC: DN23467

CERTIFICATIONS :

• Inhalation Sedation

# DN23995 Goulding, Mark

NPI: 1912493677 LIC: DN23995

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN23390 Hong, Hetty

NPI: 1659863678 LIC: DN23390

CERTIFICATIONS :

# DN23594 Ittel, James

NPI: 1932694494 LIC: DN23594

CERTIFICATIONS :

# DN22858 Kang, Youngjn

NPI: 1538680053 LIC: DN22858

CERTIFICATIONS :

• Inhalation Sedation

# DN22365 Karapasha, Christopher

NPI: 1538601455 LIC: DN22365

CERTIFICATIONS :

• Inhalation Sedation

# DN22658 Laurey, Violet

NPI: 1194254789 LIC: DN22658

CERTIFICATIONS :

• Inhalation Sedation

# DN22815 LeBlanc, Malory

NPI: 1245753912 LIC: DN22815

CERTIFICATIONS :

# DN22832 Letteri, Nicholas

NPI: 1992237937 LIC: DN22832

CERTIFICATIONS :

# DN24441 Luong, Thinh

NPI: 1619237187 LIC: DN24441

CERTIFICATIONS :

# DN21456 Mora, Viviana

NPI: 1811372154 LIC: DN21456

CERTIFICATIONS :

# DN24190 Munro, Matthew

NPI: 1174182091 LIC: DN24190

CERTIFICATIONS :

# DN23461 Musselman, Robert

NPI: 1588158505 LIC: DN23461

CERTIFICATIONS :

# DN24115 Nawari, Shahd

NPI: 1891354056 LIC: DN24115

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN22779 Ordonez, Margaret

NPI: 1972032795 LIC: DN22779

CERTIFICATIONS :

# DN23128 Patel, Anisha

NPI: 1124535885 LIC: DN23128

CERTIFICATIONS :

# DN22862 Patel, Mitul

NPI: 1679094197 LIC: DN22862

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20397 Prabakaran, Sakthi

NPI: 1316296916 LIC: DN20397

CERTIFICATIONS :

# DN23761 Rhodes, Anson

NPI: 1588155410 LIC: DN23761

CERTIFICATIONS :

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN21267 Roque, Jose

NPI: 1093111767 LIC: DN21267

CERTIFICATIONS :

• Inhalation Sedation

# DN17729 Sainsbury, James*

NPI: 1235342650 LIC: DN17729

CERTIFICATIONS :

# DN23634 Sciarrino, Elizabeth

NPI: 1942796602 LIC: DN23634

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN22755 Shah, Priya

NPI: 1528584919 LIC: DN22755

CERTIFICATIONS :

# DN24327 Sorsok, Matthew

NPI: 1194387118 LIC: DN24327

CERTIFICATIONS :

# DN24318 Treyz, Carl

NPI: 1679133276 LIC: DN24318

CERTIFICATIONS :

# DN20156 Van, Phu

NPI: 1982043451 LIC: DN20156

CERTIFICATIONS :

# DN24098 Wild, Caitlin

NPI: 1912566142 LIC: DN24098

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 265 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#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 :

#011579

Siesta Family Dentistry

2171 Siesta Dr

Sarasota, FL 34239

(941) 556-9538

Special Needs: No

English, Farsi, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN14696 Arshadi, Eftekhar

NPI: 1497851851 LIC: DN14696

CERTIFICATIONS :

ENDODONTICS

#013934

Greenberg Dental & Orthodontics

4280 Bee Ridge Rd.

Sarasota, FL 34233

(941) 363-6381

Special Needs: Yes

English, Spanish

M-T 7am-6pm

W-Th 7am-6pm

S 7am - 2pm

# DN23380 Hernandez Moreno, Rosa

NPI: 1124510508 LIC: DN23380

CERTIFICATIONS :

ORAL SURGEON

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#023022

Florida Orthodontic Associates

PLLC

5561 Broadcast Ct

Sarasota, FL 34240

(941) 727-0025

Special Needs: Yes

English

M-T 7am-5pm

W-F 7am-5pm

# DN23098 Angeloni, Mark

NPI: 1881047843 LIC: DN23098

CERTIFICATIONS :

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#016110

Florida Pediatric Dental Associates

5561 Broadcast Ct

Sarasota, FL 34240

www.allsmiles.com

(727) 205-0036

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN10571 McDowell, Ernest

NPI: 1275682023 LIC: DN10571

CERTIFICATIONS :

• Board Certification

#013934

Greenberg Dental & Orthodontics

4280 Bee Ridge Rd.

Sarasota, FL 34233

(941) 363-6381

Special Needs: Yes

English, Spanish

M-T 7am-6pm

W-Th 7am-6pm

S 7am - 2pm

# DN20464 Guloy, Robertzon*

NPI: 1659533883 LIC: DN20464

CERTIFICATIONS :

# DN22319 Hasan, Shadiya*

NPI: 1376033654 LIC: DN22319

CERTIFICATIONS :

# DN19434 Segovia, Flor*

NPI: 1932496031 LIC: DN19434

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

#020332

DAB Dental Center, PLLC

2700 S. Tamiami Trail, Ste 7

Sarasota, FL 34239

(941) 365-0800

Special Needs: Yes

English, Spanish

M 8am - 1pm, T 8am - 12pm

# DN5961 Bowles, David

NPI: 1649342635 LIC: DN5961

CERTIFICATIONS :

• General Anesthesia

#016110

Florida Pediatric Dental Associates

5561 Broadcast Ct

Sarasota, FL 34240

www.allsmiles.com

(727) 205-0036

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13950 Blankenship, Susan

NPI: 1679699383 LIC: DN13950

CERTIFICATIONS :

• Inhalation Sedation

# DN23234 Cummings, Marloin

NPI: 1467545087 LIC: DN23234

CERTIFICATIONS :

# DN17430 LaPresti, Lisa

NPI: 1386787430 LIC: DN17430

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN24376 McNair, Jonathan

NPI: 1841642154 LIC: DN24376

CERTIFICATIONS :

# DN14677 Vales, Ana-Marai

NPI: 1215146493 LIC: DN14677

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

#016943

Great Expressions Dental Centers

5278 University Parkway

Sarasota, FL 34243

(941) 260-3394

Special Needs: Yes

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

# DN19207 Bui, LoanAnh

NPI: 1003883422 LIC: DN19207

CERTIFICATIONS :

• Inhalation Sedation

# DN21333 Tate, Ashley

NPI: 1457719627 LIC: DN21333

CERTIFICATIONS :

#013934

Greenberg Dental & Orthodontics

4280 Bee Ridge Rd.

Sarasota, FL 34233

(941) 363-6381

Special Needs: Yes

English, Spanish

M-T 7am-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 266 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W-Th 7am-6pm

S 7am - 2pm

# DN21662 Adibi, Farnaz

NPI: 1902242431 LIC: DN21662

CERTIFICATIONS :

• Inhalation Sedation

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN21050 Lee, Sara

NPI: 1740673185 LIC: DN21050

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

# DN16276 Barzyk, Jeffrey*

NPI: 1578786794 LIC: DN16276

CERTIFICATIONS :

SEMINOLE COUNTY

DENTIST

#011385

Affordable Dentist, LLC

3228 W Sr 426, Ste 1000

Oviedo, FL 32765

(407) 678-3330

Special Needs: Yes

English, Spanish, Hindi

S 10am - 5pm

# DN14640 Oberoi, Ravi

NPI: 1023143229 LIC: DN14640

CERTIFICATIONS :

#009810

Ali Behzadi, D.M.D., P.A.

945 State Road 436

Casselberry, FL 32707

www.yourfamilydentalhome.com

(407) 831-4077

Special Needs: Yes

English, Farsi, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15536 Behzadi, Ali

NPI: 1558562884 LIC: DN15536

CERTIFICATIONS :

• Inhalation Sedation

# DN19047 Nabizadeh, Mandana

NPI: 1811218886 LIC: DN19047

CERTIFICATIONS :

• Inhalation Sedation

# DN22645 Qadri, Sameera

NPI: 1790957934 LIC: DN22645

CERTIFICATIONS :

• Inhalation Sedation

#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

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 :

# 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 :

#018679

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 267 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Bright Smile Dental at Oviedo,

Inc.

945 City Plaza Way #1051

Oviedo, FL 32765

http://www.brightsmileoforlando.com

(407) 542-8383

Special Needs: No

English, Spanish, Tagalog, Thai

M 3pm - 6pm, T 9am - 12pm

W 3pm-6pm,

# DN17990 Jaraplasan, Romy

NPI: 1770762882 LIC: DN17990

CERTIFICATIONS :

# DN17989 Thanasasavat, Sirin

NPI: 1437347101 LIC: DN17989

CERTIFICATIONS :

#020454

Dental Spa

205 Towne Centre Blvd

Sanford, FL 32771

(407) 330-3601

Special Needs: No

English, Spanish

M-T 8am-5pm

Th-F 8am-5pm

# DN17275 Pittman, Deirdre

NPI: 1346220530 LIC: DN17275

CERTIFICATIONS :

• Inhalation Sedation

#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

#007704

Elite Dental

851 West State Road, 436 Ste #1021

Altamonte Springs, FL 32714

(407) 786-5559

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 9am - 5pm

W 9am-5pm, Th 8am-4pm,F 8am-2pm

# DN18862 Bermudez, Juliana

NPI: 1306159165 LIC: DN18862

CERTIFICATIONS :

#015134

Greenberg Dental - Altamonte

Springs

926 Great Pond Dr, Ste 1000

Altamonte Springs, FL 32714

(407) 862-0444

Special Needs: Yes

English, Spanish

M-T 7am-7pm

Th-F 7am-3pm

S 8am - 3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

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 268 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015133

Greenberg Dental - Casselberry

879 State Rd 436

Casselberry, FL 32707

(407) 767-7600

Special Needs: Yes

English, Spanish, Gujarati, Hindi

M 9am - 5pm, T 11am - 7pm

W-F 7am-3pm

S 7am - 1pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

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 269 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#007474

Greenberg Dental - Lake Mary

3639 S. Orlando Dr

Sanford, FL 32773

(407) 347-4814

Special Needs: Yes

Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

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 270 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

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 271 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015108

Greenberg Dental - Oviedo

1500 Alafaya Trail, Ste # 1064

Oviedo, FL 32765

(407) 977-1600

Special Needs: Yes

Spanish, Vietnamese

M-T 9am-7pm

W-Th 11am-7pm

S 8am - 1pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23434 Chohan, Sumera

NPI: 1922592609 LIC: DN23434

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

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 272 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015131

Greenberg Dental - Sanford

819 E. First St, Ste 9

Sanford, FL 32771

(407) 323-8180

Special Needs: No

English, Spanish, Filipino; Pilipino,

Tagalog

M-T 10am-6pm

W 8am-4pm, Th 10am-6pm,F

8am-4pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

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 273 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#007864

James Ho, DMD PA

430 Waymont Ct., Ste 110

Lake Mary, FL 32746

(407) 322-1688

Special Needs: Yes

Chinese Mandarin, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN12719 Ho, James

NPI: 1124247366 LIC: DN12719

CERTIFICATIONS :

#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 :

#013153

Oviedo Dental Center, PA

2959 Alafaya Trail, Ste 109

Oviedo, FL 32765

(407) 366-2363

Special Needs: No

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN14220 Seoane, Maritza

NPI: 1700134194 LIC: DN14220

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 :

#011087

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 274 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Sanford Plaza Dental Center

2921 S Orlando Drive, Ste 146

Sanford, FL 32773

(407) 322-9992

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN8441 Marini, Ronald

NPI: 1750361473 LIC: DN8441

CERTIFICATIONS :

#013247

Willie B. Sherman Jr.

217 S. Oak Ave

Sanford, FL 32771

(407) 321-0190

Special Needs: Yes

English

M 9am - 5pm,

W 9am-12pm,

# DN6455 Sherman, Willie

NPI: 1982956447 LIC: DN6455

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 :

#015134

Greenberg Dental - Altamonte

Springs

926 Great Pond Dr, Ste 1000

Altamonte Springs, FL 32714

(407) 862-0444

Special Needs: Yes

English, Spanish

M-T 7am-7pm

Th-F 7am-3pm

S 8am - 3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015133

Greenberg Dental - Casselberry

879 State Rd 436

Casselberry, FL 32707

(407) 767-7600

Special Needs: Yes

English, Spanish, Gujarati, Hindi

M 9am - 5pm, T 11am - 7pm

W-F 7am-3pm

S 7am - 1pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#007474

Greenberg Dental - Lake Mary

3639 S. Orlando Dr

Sanford, FL 32773

(407) 347-4814

Special Needs: Yes

Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015108

Greenberg Dental - Oviedo

1500 Alafaya Trail, Ste # 1064

Oviedo, FL 32765

(407) 977-1600

Special Needs: Yes

Spanish, Vietnamese

M-T 9am-7pm

W-Th 11am-7pm

S 8am - 1pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

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 275 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015131

Greenberg Dental - Sanford

819 E. First St, Ste 9

Sanford, FL 32771

(407) 323-8180

Special Needs: No

English, Spanish, Filipino; Pilipino,

Tagalog

M-T 10am-6pm

W 8am-4pm, Th 10am-6pm,F

8am-4pm

# DN19321 Bienias, Russell

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

ORAL SURGEON

#015134

Greenberg Dental - Altamonte

Springs

926 Great Pond Dr, Ste 1000

Altamonte Springs, FL 32714

(407) 862-0444

Special Needs: Yes

English, Spanish

M-T 7am-7pm

Th-F 7am-3pm

S 8am - 3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015133

Greenberg Dental - Casselberry

879 State Rd 436

Casselberry, FL 32707

(407) 767-7600

Special Needs: Yes

English, Spanish, Gujarati, Hindi

M 9am - 5pm, T 11am - 7pm

W-F 7am-3pm

S 7am - 1pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#007474

Greenberg Dental - Lake Mary

3639 S. Orlando Dr

Sanford, FL 32773

(407) 347-4814

Special Needs: Yes

Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015108

Greenberg Dental - Oviedo

1500 Alafaya Trail, Ste # 1064

Oviedo, FL 32765

(407) 977-1600

Special Needs: Yes

Spanish, Vietnamese

M-T 9am-7pm

W-Th 11am-7pm

S 8am - 1pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

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 276 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015131

Greenberg Dental - Sanford

819 E. First St, Ste 9

Sanford, FL 32771

(407) 323-8180

Special Needs: No

English, Spanish, Filipino; Pilipino,

Tagalog

M-T 10am-6pm

W 8am-4pm, Th 10am-6pm,F

8am-4pm

# DN19573 Adams, Bryan

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#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

ORTHODONTIST

#011088

Advanced Orthodontic Practices

100 Lake Shore Drive, Ste 104

Altamonte Springs, FL 32714

(407) 628-9523

Special Needs: Yes

English

M-T 8am-5pm

W 8am-5pm,

# DN8121 Bryant Jr., Walter

NPI: 1073723003 LIC: DN8121

CERTIFICATIONS :

#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

# DN13474 Gittess, Laurie

NPI: 1346321031 LIC: DN13474

CERTIFICATIONS :

# DN19915 Naghavi, Nona

NPI: 1649318262 LIC: DN19915

CERTIFICATIONS :

# DN15216 Nelson, Stephen

NPI: 1629038567 LIC: DN15216

CERTIFICATIONS :

#015134

Greenberg Dental - Altamonte

Springs

926 Great Pond Dr, Ste 1000

Altamonte Springs, FL 32714

(407) 862-0444

Special Needs: Yes

English, Spanish

M-T 7am-7pm

Th-F 7am-3pm

S 8am - 3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015133

Greenberg Dental - Casselberry

879 State Rd 436

Casselberry, FL 32707

(407) 767-7600

Special Needs: Yes

English, Spanish, Gujarati, Hindi

M 9am - 5pm, T 11am - 7pm

W-F 7am-3pm

S 7am - 1pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#007474

Greenberg Dental - Lake Mary

3639 S. Orlando Dr

Sanford, FL 32773

(407) 347-4814

Special Needs: Yes

Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

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 277 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015108

Greenberg Dental - Oviedo

1500 Alafaya Trail, Ste # 1064

Oviedo, FL 32765

(407) 977-1600

Special Needs: Yes

Spanish, Vietnamese

M-T 9am-7pm

W-Th 11am-7pm

S 8am - 1pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015131

Greenberg Dental - Sanford

819 E. First St, Ste 9

Sanford, FL 32771

(407) 323-8180

Special Needs: No

English, Spanish, Filipino; Pilipino,

Tagalog

M-T 10am-6pm

W 8am-4pm, Th 10am-6pm,F

8am-4pm

# DN17521 Aaron, Scott

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#023032

Vitral Orthodontics, PA

114 Wilshire Blvd

Casselberry, FL 32707

(407) 907-6361

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 8am-7pm

S 9am - 5pm

# DN23206 Santana, Lillelenny

NPI: 1225391154 LIC: DN23206

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#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

# DN18945 Choice, Jeresia

NPI: 1841587730 LIC: DN18945

CERTIFICATIONS :

• Inhalation Sedation

# DN19077 Edwards, Jenny

NPI: 1689989071 LIC: DN19077

CERTIFICATIONS :

• Board Certification

# DN19581 Sirage, Mohamed

NPI: 1255688065 LIC: DN19581

CERTIFICATIONS :

• Inhalation Sedation

#015134

Greenberg Dental - Altamonte

Springs

926 Great Pond Dr, Ste 1000

Altamonte Springs, FL 32714

(407) 862-0444

Special Needs: Yes

English, Spanish

M-T 7am-7pm

Th-F 7am-3pm

S 8am - 3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

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 278 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015133

Greenberg Dental - Casselberry

879 State Rd 436

Casselberry, FL 32707

(407) 767-7600

Special Needs: Yes

English, Spanish, Gujarati, Hindi

M 9am - 5pm, T 11am - 7pm

W-F 7am-3pm

S 7am - 1pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#007474

Greenberg Dental - Lake Mary

3639 S. Orlando Dr

Sanford, FL 32773

(407) 347-4814

Special Needs: Yes

Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015108

Greenberg Dental - Oviedo

1500 Alafaya Trail, Ste # 1064

Oviedo, FL 32765

(407) 977-1600

Special Needs: Yes

Spanish, Vietnamese

M-T 9am-7pm

W-Th 11am-7pm

S 8am - 1pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015131

Greenberg Dental - Sanford

819 E. First St, Ste 9

Sanford, FL 32771

(407) 323-8180

Special Needs: No

English, Spanish, Filipino; Pilipino,

Tagalog

M-T 10am-6pm

W 8am-4pm, Th 10am-6pm,F

8am-4pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

PERIODONTICS

#009751

Altamonte Mall Dental

451 Altamonte Dr Ste, 1279

Altamonte Springs, FL 32701

(407) 261-0201

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 279 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Russian, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN13591 Nielsen, Pamela

NPI: 1124118245 LIC: DN13591

CERTIFICATIONS :

#015134

Greenberg Dental - Altamonte

Springs

926 Great Pond Dr, Ste 1000

Altamonte Springs, FL 32714

(407) 862-0444

Special Needs: Yes

English, Spanish

M-T 7am-7pm

Th-F 7am-3pm

S 8am - 3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015133

Greenberg Dental - Casselberry

879 State Rd 436

Casselberry, FL 32707

(407) 767-7600

Special Needs: Yes

English, Spanish, Gujarati, Hindi

M 9am - 5pm, T 11am - 7pm

W-F 7am-3pm

S 7am - 1pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#007474

Greenberg Dental - Lake Mary

3639 S. Orlando Dr

Sanford, FL 32773

(407) 347-4814

Special Needs: Yes

Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

#015108

Greenberg Dental - Oviedo

1500 Alafaya Trail, Ste # 1064

Oviedo, FL 32765

(407) 977-1600

Special Needs: Yes

Spanish, Vietnamese

M-T 9am-7pm

W-Th 11am-7pm

S 8am - 1pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015131

Greenberg Dental - Sanford

819 E. First St, Ste 9

Sanford, FL 32771

(407) 323-8180

Special Needs: No

English, Spanish, Filipino; Pilipino,

Tagalog

M-T 10am-6pm

W 8am-4pm, Th 10am-6pm,F

8am-4pm

# DN20860 Garcia, Daniel

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

PROSTHODONTICS

#015134

Greenberg Dental - Altamonte

Springs

926 Great Pond Dr, Ste 1000

Altamonte Springs, FL 32714

(407) 862-0444

Special Needs: Yes

English, Spanish

M-T 7am-7pm

Th-F 7am-3pm

S 8am - 3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015133

Greenberg Dental - Casselberry

879 State Rd 436

Casselberry, FL 32707

(407) 767-7600

Special Needs: Yes

English, Spanish, Gujarati, Hindi

M 9am - 5pm, T 11am - 7pm

W-F 7am-3pm

S 7am - 1pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#007474

Greenberg Dental - Lake Mary

3639 S. Orlando Dr

Sanford, FL 32773

(407) 347-4814

Special Needs: Yes

Spanish

M-T 10am-6pm

W-F 7am-3pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015108

Greenberg Dental - Oviedo

1500 Alafaya Trail, Ste # 1064

Oviedo, FL 32765

(407) 977-1600

Special Needs: Yes

Spanish, Vietnamese

M-T 9am-7pm

W-Th 11am-7pm

S 8am - 1pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015131

Greenberg Dental - Sanford

819 E. First St, Ste 9

Sanford, FL 32771

(407) 323-8180

Special Needs: No

English, Spanish, Filipino; Pilipino,

Tagalog

M-T 10am-6pm

W 8am-4pm, Th 10am-6pm,F

8am-4pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

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

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 280 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# 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

#CHC010310

DOH - Suwannee County Health

Department

915 Nobles Ferry Rd

Live Oak, FL 32064

(386) 362-2708

Special Needs: Yes

English, Spanish

W 8am-5pm,

# DN12159 Hill, Elizabeth

NPI: 1760490734 LIC: DN12159

CERTIFICATIONS :

#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 :

#011282

Daytona Pediatric Dentistry

1021 S. Ridgewood Ave

Daytona Beach, FL 32114

(386) 304-2677

Special Needs: Yes

English, Spanish, Portuguese, Urdu

T 8am - 5pm

W-Th 8am-5pm

# DN19150 Howard, Belisa

NPI: 1548573363 LIC: DN19150

CERTIFICATIONS :

• Inhalation Sedation

#CHC014791

DOH - Volusia County Health

Department

775 Harley Strickland Drive, Ste 110

Orange City, FL 32763

(386) 274-0896

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19698 Aliev, Ulan

NPI: 1972866994 LIC: DN19698

CERTIFICATIONS :

# DN11833 Lim, Peter

NPI: 1821022526 LIC: DN11833

CERTIFICATIONS :

# DN15461 Nguyen, Christine

NPI: 1306988050 LIC: DN15461

CERTIFICATIONS :

# DN12760 Nguyen, Huong

NPI: 1720350572 LIC: DN12760

CERTIFICATIONS :

# DN15309 Orlando, Denise

NPI: 1700819349 LIC: DN15309

CERTIFICATIONS :

# DN15310 Orlando, Michael

NPI: 1174557870 LIC: DN15310

CERTIFICATIONS :

#CHC10220

DOH - Volusia County Health

Department

1845 Holsonback Drive

Daytona Beach, FL 32117

(386) 274-0896

Special Needs: Yes

English, Spanish, Tagalog

M-T 8am-5pm

W-F 8am-5pm

# DN19698 Aliev, Ulan

NPI: 1972866994 LIC: DN19698

CERTIFICATIONS :

# DN15461 Nguyen, Christine

NPI: 1306988050 LIC: DN15461

CERTIFICATIONS :

# DN12760 Nguyen, Huong

NPI: 1720350572 LIC: DN12760

CERTIFICATIONS :

# DN15309 Orlando, Denise

NPI: 1700819349 LIC: DN15309

CERTIFICATIONS :

# DN15310 Orlando, Michael

NPI: 1174557870 LIC: DN15310

CERTIFICATIONS :

#010772

Family Dentistry of Daytona

Beach, LLC

244 N Frederick Ave

Daytona Beach, FL 32114

(386) 255-0238

Special Needs: No

English, Spanish

M-T 8am-5pm

W 8am-2pm, Th 8am-5pm,F 8am-2pm

# DN9896 Quarterman, Robbin

NPI: 1962539197 LIC: DN9896

CERTIFICATIONS :

#FQHC020653

Family Health Source

1205 Woodland Blvd, Ste 5

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 281 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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 :

#015109

Greenberg Dental - Daytona Beach

1515 S. Nova Rd

Daytona Beach, FL 32114

(386) 947-9318

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 8am-5pm,F 8am-4pm

S 8am - 12pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

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 282 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015114

Greenberg Dental - Deland

2641 S. Woodland Blvd

Deland, FL 32720

(386) 738-7441

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 7am-4pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle*

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

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 283 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015130

Greenberg Dental - Deltona

777 Deltona Blvd, Ste 9

Deltona, FL 32725

(386) 574-4407

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 4pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

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 284 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#015117

Greenberg Dental - Port Orange

4003 S. Nova Rd

Port Orange, FL 32127

(386) 763-2000

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 2pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN19373 Carter, Ben

NPI: 1851679666 LIC: DN19373

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

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 285 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN20746 Ferreira, Stephanie

NPI: 1699175745 LIC: DN20746

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN20809 Nasseri, Sanaz

NPI: 1295142370 LIC: DN20809

CERTIFICATIONS :

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN20882 Patel, Janisha

NPI: 1740689371 LIC: DN20882

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20239 Phan, Christine

NPI: 1871933846 LIC: DN20239

CERTIFICATIONS :

• Inhalation Sedation

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

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 286 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#011215

Greenberg Dental & Orthodontics

1462 W. Granada Blvd, Ste 210

Ormond Beach, FL 32174

(386) 675-1711

Special Needs: Yes

Spanish, English

M-T 10am-6pm

W-F 8am-4pm

# DN11922 Amaro, David

NPI: 1528120383 LIC: DN11922

CERTIFICATIONS :

# DN18014 Baker, James*

NPI: 1467650648 LIC: DN18014

CERTIFICATIONS :

• Inhalation Sedation

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN23294 Brambila, Danielle

NPI: 1720577703 LIC: DN23294

CERTIFICATIONS :

• Inhalation Sedation

# DN23374 Calhoun, Steven

NPI: 1942792916 LIC: DN23374

CERTIFICATIONS :

# DN23364 Collier, Richard

NPI: 1154813749 LIC: DN23364

CERTIFICATIONS :

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN19357 Correal, Juliana

NPI: 1811281710 LIC: DN19357

CERTIFICATIONS :

# DN14554 Daccache, Danny

NPI: 1376502104 LIC: DN14554

CERTIFICATIONS :

# 059393 Dirawi, Sam

NPI: 1366863250 LIC: 059393

CERTIFICATIONS :

# DN21288 Do, TuTrinh

NPI: 1760863864 LIC: DN21288

CERTIFICATIONS :

# DN24633 Dobrozdravic, Amy

NPI: 1922584291 LIC: DN24633

CERTIFICATIONS :

# DN15963 Doherty, Nicole

NPI: 1780637736 LIC: DN15963

CERTIFICATIONS :

• Inhalation Sedation

# DN22845 Estrada, Manuel

NPI: 1306378146 LIC: DN22845

CERTIFICATIONS :

• Inhalation Sedation

# DN21317 Feng, Connie

NPI: 1689057432 LIC: DN21317

CERTIFICATIONS :

# DN23150 Ferbinteanu, Nadine

NPI: 1841743416 LIC: DN23150

CERTIFICATIONS :

# DN19348 Fidy, Ramez

NPI: 1629362686 LIC: DN19348

CERTIFICATIONS :

# DN20798 Freeman, Michael

NPI: 1023351020 LIC: DN20798

CERTIFICATIONS :

# DN24130 Gaddy IV, Grover

NPI: 1952962508 LIC: DN24130

CERTIFICATIONS :

# DN21287 Gannon, Robert

NPI: 1285051235 LIC: DN21287

CERTIFICATIONS :

# DN20291 Garcia, Maritza

NPI: 1801238340 LIC: DN20291

CERTIFICATIONS :

# DN20164 Gollob, Harrison

NPI: 1891134441 LIC: DN20164

CERTIFICATIONS :

• Inhalation Sedation

# DN21892 Gonzalez, Lisset

NPI: 1376992230 LIC: DN21892

CERTIFICATIONS :

# DN23110 Greenberg, Adam

NPI: 1295240646 LIC: DN23110

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN18788 Greenberg, Martin

NPI: 1154559870 LIC: DN18788

CERTIFICATIONS :

# DN22743 Hoang, Nhon

NPI: 1518472547 LIC: DN22743

CERTIFICATIONS :

# DN22912 Jones, Nathan

NPI: 1306369830 LIC: DN22912

CERTIFICATIONS :

# DN18557 Kamat, Amit

NPI: 1568613081 LIC: DN18557

CERTIFICATIONS :

• Board Certification

# DN19947 Lombana-Cano, Edward

NPI: 1306198619 LIC: DN19947

CERTIFICATIONS :

• Inhalation Sedation

# DN22593 Lopez, Aliuska

NPI: 1083143317 LIC: DN22593

CERTIFICATIONS :

• Inhalation Sedation

# DN20943 Marin-Jimenez, Laura

NPI: 1457751075 LIC: DN20943

CERTIFICATIONS :

# DN23072 Mezquia, Freddy

NPI: 1679095970 LIC: DN23072

CERTIFICATIONS :

• Inhalation Sedation

# DN18535 Nguyen, Duy

NPI: 1205075090 LIC: DN18535

CERTIFICATIONS :

# DN14906 Nguyen, Dzung

NPI: 1093775280 LIC: DN14906

CERTIFICATIONS :

# DN20145 Nguyen, Hoang

NPI: 1407295207 LIC: DN20145

CERTIFICATIONS :

# DN23549 Nguyen, Linda

NPI: 1972039493 LIC: DN23549

CERTIFICATIONS :

# DN22213 Niroumand, Farinaz

NPI: 1265987887 LIC: DN22213

CERTIFICATIONS :

# DN17439 Nunez, Erick

NPI: 1043242969 LIC: DN17439

CERTIFICATIONS :

# DN21822 Ortiz-Pimentel, Edgar

NPI: 1699055178 LIC: DN21822

CERTIFICATIONS :

# DN21449 Paiva, Heber

NPI: 1952786535 LIC: DN21449

CERTIFICATIONS :

# DN22580 Patel, Maitri

NPI: 1447770516 LIC: DN22580

CERTIFICATIONS :

# DN24250 Patel, Nishka

NPI: 1134788367 LIC: DN24250

CERTIFICATIONS :

# DN19097 Patel, Ripal

NPI: 1265743660 LIC: DN19097

CERTIFICATIONS :

# DN22740 Patel, Vicky

NPI: 1548780281 LIC: DN22740

CERTIFICATIONS :

# DN21937 Patel, Yesha

NPI: 1801246160 LIC: DN21937

CERTIFICATIONS :

# DN21865 Pham, Quyen

NPI: 1023467925 LIC: DN21865

CERTIFICATIONS :

# DN20411 Rivera, Abneris

NPI: 1467710160 LIC: DN20411

CERTIFICATIONS :

# DN20541 Rizziello, Derrick

NPI: 1235559410 LIC: DN20541

CERTIFICATIONS :

• Inhalation Sedation

# DN23563 Robinson Maita, Santos

NPI: 1063999613 LIC: DN23563

CERTIFICATIONS :

# DN23391 Rodriguez Leyva, Luis

NPI: 1639661010 LIC: DN23391

CERTIFICATIONS :

# DN23420 Rosario-Aristy, Grissel

NPI: 1255826525 LIC: DN23420

CERTIFICATIONS :

# DN17392 Sehgal, Mamta

NPI: 1750393112 LIC: DN17392

CERTIFICATIONS :

# DN24269 Sehgal, Tanya

NPI: 1538728654 LIC: DN24269

CERTIFICATIONS :

# DN21274 Seoane, Andres

NPI: 1356722581 LIC: DN21274

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 287 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN21816 Shields, Nastassia

NPI: 1093198301 LIC: DN21816

CERTIFICATIONS :

# DN19334 Tran, Faye

NPI: 1104110618 LIC: DN19334

CERTIFICATIONS :

# DN22084 Tran, Ivy

NPI: 1295187516 LIC: DN22084

CERTIFICATIONS :

# DN19700 Varela, Monica

NPI: 1477814689 LIC: DN19700

CERTIFICATIONS :

• Inhalation Sedation

# DN22072 Voaonsri, Nopparat

NPI: 1912359373 LIC: DN22072

CERTIFICATIONS :

# DN24038 Vu, Annie

NPI: 1184188120 LIC: DN24038

CERTIFICATIONS :

# DN19575 Walker, Aaron

NPI: 1932399284 LIC: DN19575

CERTIFICATIONS :

# DN12570 Ward, Michael

NPI: 1528028792 LIC: DN12570

CERTIFICATIONS :

# DN22631 Williams, Hanief

NPI: 1932620952 LIC: DN22631

CERTIFICATIONS :

# DN21835 Yu, Lina

NPI: 1427406529 LIC: DN21835

CERTIFICATIONS :

#010841

Terry C. Blanks, Jr, DDS, PA

895 S. Dexter Ave

Deland, FL 32720

(386) 738-2002

Special Needs: Yes

English, Spanish

M 9am - 3pm, T 9am - 5pm

# DN5526 Blanks, Terry

NPI: 1154660819 LIC: DN5526

CERTIFICATIONS :

• Conscious Sedation

ENDODONTICS

#015109

Greenberg Dental - Daytona Beach

1515 S. Nova Rd

Daytona Beach, FL 32114

(386) 947-9318

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 8am-5pm,F 8am-4pm

S 8am - 12pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015114

Greenberg Dental - Deland

2641 S. Woodland Blvd

Deland, FL 32720

(386) 738-7441

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 7am-4pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015130

Greenberg Dental - Deltona

777 Deltona Blvd, Ste 9

Deltona, FL 32725

(386) 574-4407

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 4pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#015117

Greenberg Dental - Port Orange

4003 S. Nova Rd

Port Orange, FL 32127

(386) 763-2000

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 2pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

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 288 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

#011215

Greenberg Dental & Orthodontics

1462 W. Granada Blvd, Ste 210

Ormond Beach, FL 32174

(386) 675-1711

Special Needs: Yes

Spanish, English

M-T 10am-6pm

W-F 8am-4pm

# DN19321 Bienias, Russell*

NPI: 1144516287 LIC: DN19321

CERTIFICATIONS :

# DN22843 Carmona, Ashley

NPI: 1871018770 LIC: DN22843

CERTIFICATIONS :

# DN18944 Cherian, Shiju*

NPI: 1306164876 LIC: DN18944

CERTIFICATIONS :

# DN22842 Lopez, Matthew

NPI: 1932622917 LIC: DN22842

CERTIFICATIONS :

# DN18183 Marcos-Arenal, Jose*

NPI: 1518143775 LIC: DN18183

CERTIFICATIONS :

# DN19593 Mir, Hamza*

NPI: 1194094938 LIC: DN19593

CERTIFICATIONS :

# DN24049 Piner, James

NPI: 1023677135 LIC: DN24049

CERTIFICATIONS :

# DN21852 Priemer, Ryan

NPI: 1427407634 LIC: DN21852

CERTIFICATIONS :

• Inhalation Sedation

# DN5060 Schwartz II, William*

NPI: 1437370640 LIC: DN5060

CERTIFICATIONS :

# DN19908 Sreekantaiah, Kiran*

NPI: 1437406527 LIC: DN19908

CERTIFICATIONS :

• Inhalation Sedation

# DN24280 Ton, Vera

NPI: 1003476623 LIC: DN24280

CERTIFICATIONS :

ORAL SURGEON

#015109

Greenberg Dental - Daytona Beach

1515 S. Nova Rd

Daytona Beach, FL 32114

(386) 947-9318

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 8am-5pm,F 8am-4pm

S 8am - 12pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015114

Greenberg Dental - Deland

2641 S. Woodland Blvd

Deland, FL 32720

(386) 738-7441

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 7am-4pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015130

Greenberg Dental - Deltona

777 Deltona Blvd, Ste 9

Deltona, FL 32725

(386) 574-4407

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 4pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#015117

Greenberg Dental - Port Orange

4003 S. Nova Rd

Port Orange, FL 32127

(386) 763-2000

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 2pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

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 289 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#011215

Greenberg Dental & Orthodontics

1462 W. Granada Blvd, Ste 210

Ormond Beach, FL 32174

(386) 675-1711

Special Needs: Yes

Spanish, English

M-T 10am-6pm

W-F 8am-4pm

# DN19573 Adams, Bryan*

NPI: 1861557837 LIC: DN19573

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN9409 Burchfield, Tommie*

NPI: 1639138274 LIC: DN9409

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16923 Lawson, Scott*

NPI: 1467470781 LIC: DN16923

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

# DN20364 Sterrett, David*

NPI: 1457589228 LIC: DN20364

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

ORTHODONTIST

#015109

Greenberg Dental - Daytona Beach

1515 S. Nova Rd

Daytona Beach, FL 32114

(386) 947-9318

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 8am-5pm,F 8am-4pm

S 8am - 12pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015114

Greenberg Dental - Deland

2641 S. Woodland Blvd

Deland, FL 32720

(386) 738-7441

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 7am-4pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015130

Greenberg Dental - Deltona

777 Deltona Blvd, Ste 9

Deltona, FL 32725

(386) 574-4407

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 4pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#015117

Greenberg Dental - Port Orange

4003 S. Nova Rd

Port Orange, FL 32127

(386) 763-2000

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 2pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

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 290 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN20543 Pawlak, Caroline*

NPI: 1316364458 LIC: DN20543

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

#011215

Greenberg Dental & Orthodontics

1462 W. Granada Blvd, Ste 210

Ormond Beach, FL 32174

(386) 675-1711

Special Needs: Yes

Spanish, English

M-T 10am-6pm

W-F 8am-4pm

# DN17521 Aaron, Scott*

NPI: 1922248442 LIC: DN17521

CERTIFICATIONS :

• Board Certification

# DN18011 Adams, Timothy*

NPI: 1891884367 LIC: DN18011

CERTIFICATIONS :

# DN22190 Biagini Palombi, Anna*

NPI: 1245776418 LIC: DN22190

CERTIFICATIONS :

# DN23132 Burns, Richard*

NPI: 1073643656 LIC: DN23132

CERTIFICATIONS :

# DN22141 Byun, Paul*

NPI: 1740842764 LIC: DN22141

CERTIFICATIONS :

# DN17547 Hamdallah, Khaled*

NPI: 1063629228 LIC: DN17547

CERTIFICATIONS :

# DN19901 Lakshmana, Shruthi*

NPI: 1659763092 LIC: DN19901

CERTIFICATIONS :

# DN19330 Murray, Andrew*

NPI: 1275811135 LIC: DN19330

CERTIFICATIONS :

# DN23530 Pham, Andrew*

NPI: 1316433865 LIC: DN23530

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#011282

Daytona Pediatric Dentistry

1021 S. Ridgewood Ave

Daytona Beach, FL 32114

(386) 304-2677

Special Needs: Yes

English, Spanish, Portuguese, Urdu

T 8am - 5pm

W-Th 8am-5pm

# DN20759 Arruda, Moema

NPI: 1548678998 LIC: DN20759

CERTIFICATIONS :

• Inhalation Sedation

# DN13783 Chaudhry, Mubashir

NPI: 1861490864 LIC: DN13783

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN24580 Greene, Stephen

NPI: 1194113373 LIC: DN24580

CERTIFICATIONS :

#CHC014791

DOH - Volusia County Health

Department

775 Harley Strickland Drive, Ste 110

Orange City, FL 32763

(386) 274-0896

Special Needs: Yes

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13923 Rodriguez-Viera, Arelis

NPI: 1225048119 LIC: DN13923

CERTIFICATIONS :

#CHC10220

DOH - Volusia County Health

Department

1845 Holsonback Drive

Daytona Beach, FL 32117

(386) 274-0896

Special Needs: Yes

English, Spanish, Tagalog

M-T 8am-5pm

W-F 8am-5pm

# DN13923 Rodriguez-Viera, Arelis

NPI: 1225048119 LIC: DN13923

CERTIFICATIONS :

#015109

Greenberg Dental - Daytona Beach

1515 S. Nova Rd

Daytona Beach, FL 32114

(386) 947-9318

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 8am-5pm,F 8am-4pm

S 8am - 12pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015114

Greenberg Dental - Deland

2641 S. Woodland Blvd

Deland, FL 32720

(386) 738-7441

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 7am-4pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

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 291 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015130

Greenberg Dental - Deltona

777 Deltona Blvd, Ste 9

Deltona, FL 32725

(386) 574-4407

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 4pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#015117

Greenberg Dental - Port Orange

4003 S. Nova Rd

Port Orange, FL 32127

(386) 763-2000

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 2pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#011215

Greenberg Dental & Orthodontics

1462 W. Granada Blvd, Ste 210

Ormond Beach, FL 32174

(386) 675-1711

Special Needs: Yes

Spanish, English

M-T 10am-6pm

W-F 8am-4pm

# DN18391 Harrell, Laurie

NPI: 1568625846 LIC: DN18391

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN21745 Hermano, Mark

NPI: 1902342264 LIC: DN21745

CERTIFICATIONS :

# DN22366 Iyer, Priyanka

NPI: 1477971919 LIC: DN22366

CERTIFICATIONS :

• Inhalation Sedation

# DN19477 Ojeda Jr., Juan

NPI: 1861786949 LIC: DN19477

CERTIFICATIONS :

• Inhalation Sedation

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN19534 Van, Vincent

NPI: 1942296942 LIC: DN19534

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN18638 Yeung, Vincent

NPI: 1356570956 LIC: DN18638

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

#011291

Main Street Children's Dentistry

& Orthodontics of Orange PA

2435 S Volusia Ave Ste D-2

Orange City, FL 32763

(386) 775-0833

Special Needs: Yes

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN21046 Perez, Marina

NPI: 1568850972 LIC: DN21046

CERTIFICATIONS :

• Inhalation Sedation

# DN20826 Tejada, Rodolfo

NPI: 1427345057 LIC: DN20826

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#011660

Timothy A. Glomb DMD, PA

2808 Enterprise Rd Ste102

Debary, FL 32713

(386) 668-7776

Special Needs: Yes

English

M-T 7am-4pm

W-Th 7am-4pm

# DN13437 Glomb, Timothy*

NPI: 1255450870 LIC: DN13437

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

• Inhalation Sedation

• Pediatric Conscious Sedation

PERIODONTICS

#015109

Greenberg Dental - Daytona Beach

1515 S. Nova Rd

Daytona Beach, FL 32114

(386) 947-9318

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 292 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 8am-5pm,F 8am-4pm

S 8am - 12pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015114

Greenberg Dental - Deland

2641 S. Woodland Blvd

Deland, FL 32720

(386) 738-7441

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 7am-4pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015130

Greenberg Dental - Deltona

777 Deltona Blvd, Ste 9

Deltona, FL 32725

(386) 574-4407

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 4pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#015117

Greenberg Dental - Port Orange

4003 S. Nova Rd

Port Orange, FL 32127

(386) 763-2000

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 2pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

#011215

Greenberg Dental & Orthodontics

1462 W. Granada Blvd, Ste 210

Ormond Beach, FL 32174

(386) 675-1711

Special Needs: Yes

Spanish, English

M-T 10am-6pm

W-F 8am-4pm

# DN20860 Garcia, Daniel*

NPI: 1235530171 LIC: DN20860

CERTIFICATIONS :

# DN22055 Rosebrough, Claire*

NPI: 1093266181 LIC: DN22055

CERTIFICATIONS :

# DN18109 Yeung, Victor*

NPI: 1730407529 LIC: DN18109

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

PROSTHODONTICS

#015109

Greenberg Dental - Daytona Beach

1515 S. Nova Rd

Daytona Beach, FL 32114

(386) 947-9318

Special Needs: Yes

English, Spanish

M 8am - 4pm, T 10am - 6pm

W 8am-4pm, Th 8am-5pm,F 8am-4pm

S 8am - 12pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015114

Greenberg Dental - Deland

2641 S. Woodland Blvd

Deland, FL 32720

(386) 738-7441

Special Needs: Yes

English, Spanish

M-T 8am-7pm

W-F 7am-4pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015130

Greenberg Dental - Deltona

777 Deltona Blvd, Ste 9

Deltona, FL 32725

(386) 574-4407

Special Needs: Yes

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 4pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#015117

Greenberg Dental - Port Orange

4003 S. Nova Rd

Port Orange, FL 32127

(386) 763-2000

Special Needs: Yes

English, Spanish

M 10am - 6pm, T 8am - 4pm

W-F 8am-4pm

S 8am - 2pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

CERTIFICATIONS :

#011215

Greenberg Dental & Orthodontics

1462 W. Granada Blvd, Ste 210

Ormond Beach, FL 32174

(386) 675-1711

Special Needs: Yes

Spanish, English

M-T 10am-6pm

W-F 8am-4pm

# DN21786 Galindo-Ramirez, Ricardo

NPI: 1881982478 LIC: DN21786

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

#CHC10023

DOH - Walton County Health

Department

362 State Hwy 83

Defuniak Springs, FL 32433

(850) 892-8686

Special Needs: Yes

English, Spanish

M-T 7am-5pm

W-Th 7am-5pm

# DN23823 Maguire, Carissa

NPI: 1588893424 LIC: DN23823

CERTIFICATIONS :

• Inhalation Sedation

# DN15311 Ottesen, John

NPI: 1316087828 LIC: DN15311

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 293 of 295

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 CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#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

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 :

PEDIATRIC DENTISTRY

#018289

Panhandle Pediatric Dentistry,

PLLC

870 Mack Bayou Rd Ste A

Santa Rosa Beach, FL 32459

panhandlepediatricdentistry.com

(850) 481-1969

Special Needs: Yes

M-T 8am-4pm

W-Th 8am-4pm

# DN16280 Berry, Stephen Eric

NPI: 1699889352 LIC: DN16280

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

# DN23156 Fujawa, Douglas

NPI: 1336541135 LIC: DN23156

CERTIFICATIONS :

• Inhalation Sedation

# DN24675 Harrell, Robbie

NPI: 1780113944 LIC: DN24675

CERTIFICATIONS :

# DN23264 Johnson, Patrick

NPI: 1770932402 LIC: DN23264

CERTIFICATIONS :

• Inhalation Sedation

# DN20298 Lapointe, Lisa

NPI: 1336454701 LIC: DN20298

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious Sedation

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

PEDIATRIC DENTISTRY

#020273

Panhandle Pediatric Dentistry.

PLLC

1409 Brickyard Road

Chipley, FL 32428

(850) 481-1969

Special Needs: Yes

English

M-T 7am-5pm

W-Th 7am-5pm

# DN16280 Berry, Stephen Eric*

NPI: 1699889352 LIC: DN16280

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

• Pediatric Conscious 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.

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Wheelchair access / Acceso para personas en silla de ruedas.

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID CHILD

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 295 of 295

June, 2020

06/15/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.