Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
ALACHUA COUNTY
DENTIST
#RHC010936
Acorn Clinic
23320 N. State Rd, Ste 235
Brooker, FL 32622
(352) 485-2772
Gujarati, English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN9374 Hsiung, Edwin
NPI: 1417389586 LIC: DN9374
CERTIFICATIONS :
#FQHC010440
Azalea Health
410 Ne Waldo Road
Gainesville, FL 32641
(352) 375-3790
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
English, Russian, Bulgarian, German,
Italian, Spanish
W 8am-5pm,
# DN19484 Jones, Stephanie
NPI: 1548549678 LIC: DN19484
CERTIFICATIONS :
# 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
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
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
English, Other
M-T 8am-5pm
W-F 8am-5pm
# DTP659 Migliorati, Cesar
NPI: 1992810519 LIC: DTP659
CERTIFICATIONS :
• Inhalation Sedation
# DTP623 Ruprecht, Axel
NPI: 1699763631 LIC: DTP623
CERTIFICATIONS :
ENDODONTICS
#022671
North Central Florida Endodontics
1905 Nw 13Th Street, Ste 2
Gainesville, FL 32609
(352) 375-7776
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 :
PEDIATRIC DENTISTRY
#011100
Millhopper Pediatric Dentistry, PL
2341 Nw 41St Street, Ste A
Gainesville, FL 32606
(352) 336-3939
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN15273 Beaufait, Nguyet
NPI: 1457380719 LIC: DN15273
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
• Pediatric Conscious Sedation
PROSTHODONTICS
#010755
University of Florida College of
Dentistry
1600 Sw Archer Road
Gainesville, FL 32610
www.dental.ufl.edu
(352) 273-6820
English, Other
M-T 8am-5pm
W-F 8am-5pm
# DTP467 Esquivel-Upshaw,
Josephine
NPI: 1760495527 LIC: DTP467
CERTIFICATIONS :
BAKER COUNTY
DENTIST
#CHC013141
DOH - Baker County Health
Department
480 W. Lowder St
Macclenny, FL 32063
baker.web@flhealth.gov
(904) 259-9815
M-T 8am-5pm
W-Th 8am-5pm
# DN11888 Hackney, Tara
NPI: 1710953765 LIC: DN11888
CERTIFICATIONS :
• Inhalation Sedation
BAY COUNTY
DENTIST
#CHC10280
DOH - Bay County Health
Department
3518 E. 15Th St
Panama City, FL 32404
(850) 872-4455
English, Spanish
M-T 7am-4pm
W-F 7am-4pm
# DN21103 Ghani, Rehan
NPI: 1316333230 LIC: DN21103
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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
• Inhalation Sedation
# DN18413 Morshed, Aly
NPI: 1730244948 LIC: DN18413
CERTIFICATIONS :
• Inhalation Sedation
#FQHC022012
PanCare of Florida
12427 Hwy 231
Youngstown, FL 32466
(850) 215-3575
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 :
# 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 :
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
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 :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
#FQHC010683
PanCare of Florida, Inc.
403 E. 11Th St
Panama City, FL 32401
(850) 767-3350
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 5pm
# DN19128 Claussen, Meghann
NPI: 1336454651 LIC: DN19128
CERTIFICATIONS :
# DN13094 Hudon, Richard
NPI: 1245336031 LIC: DN13094
CERTIFICATIONS :
# 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 :
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
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 :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
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
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
English
M-T 8am-4pm
W 8am-4pm,
# DN17872 Hanson, Shane
NPI: 1710907787 LIC: DN17872
CERTIFICATIONS :
• Inhalation Sedation
ORAL SURGEON
#010672
Eric R. Claussen D.M.D., P.A.
2624 Jenks Ave
Panama City, FL 32405
(850) 215-0798
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
English
M 9am - 6pm, T 8am - 5pm
W-Th 8am-5pm
# 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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Palm Bay, FL 32905
(321) 724-1343
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
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
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
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
#022011
Magic Dental Care II
1325 Pine Street, Ste 103
Melbourne, FL 32901
(321) 724-4520
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 9am - 4pm
# 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
#022718
Quality Dentures, LLC
313 N. Babcock Street
Melbourne, FL 32935
(321) 259-1949
English
T 8am - 4pm
W-Th 8am-4pm
# DN10444 Bell, E. Scott
NPI: 1093725558 LIC: DN10444
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#013507
Brevard Pediatric Dental
Associates - Merritt Island
2405 N Courtenay Pkwy Ste 105
Merritt Island, FL 32953
(321) 453-2450
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
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
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
English, Russian, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 9am - 2pm
# DN20688 Acheampong, Emmanuel
NPI: 1407122252 LIC: DN20688
CERTIFICATIONS :
• Inhalation Sedation
#022011
Magic Dental Care II
1325 Pine Street, Ste 103
Melbourne, FL 32901
(321) 724-4520
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
BROWARD COUNTY
DENTIST
#009564
A Healthy Smile Dental
12333 Nw 18Th St. Ste 2
Pembroke Pines, FL 33026
www.ahealthysmileforlife.com
(954) 885-4224
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(954) 430-5700
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
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
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
English, Russian, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN20596 Coyle, Sean
NPI: 1962814632 LIC: DN20596
CERTIFICATIONS :
# DN20696 Kopynets, Viktor
NPI: 1932517042 LIC: DN20696
CERTIFICATIONS :
• Inhalation Sedation
# DN12167 Kuntsmann, Vivian
NPI: 1104995539 LIC: DN12167
CERTIFICATIONS :
# DN24073 Martinez, Lester
NPI: 1689235624 LIC: DN24073
CERTIFICATIONS :
# DN17761 Valdman, Vadim
NPI: 1184860413 LIC: DN17761
CERTIFICATIONS :
• Inhalation Sedation
#016880
Allure Dental PLLC
4267 W. Commerical Blvd
Tamarac, FL 33319
(954) 677-3202
English, Russian, French, Spanish
M-T 9am-5pm
Th-F 9am-5pm
S 9am - 3pm
# DN20596 Coyle, Sean
NPI: 1962814632 LIC: DN20596
CERTIFICATIONS :
# 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
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
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# 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
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
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
English, Spanish, Haitian; Haitian
Creole
T 9am - 5pm
W 9am-5pm, Th 8am-5pm,F 9am-5pm
S 9am - 5pm
# DN17611 Riley, Marilyn
NPI: 1114941614 LIC: DN17611
CERTIFICATIONS :
#016082
Angelic Smiles Dental Spa
9990 Nw 6Th Court
Hollywood, FL 33024
www.angelicsmilesdentalspa.com
(954) 237-3902
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
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
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
(954) 970-7067
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
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
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 :
# DN22389 Inaba, Caroline
NPI: 1629319249 LIC: DN22389
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
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 :
# 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 :
#FQHC014907
Community AIDS Resource, Inc.
871 W. Oakland Park Blvd
Fort Lauderdale, FL 33311
(954) 567-7141
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.com
(954) 341-4766
English, Spanish, Portuguese
M-T 10am-7pm
W-F 10am-7pm
# DN14972 Stein, Ilya
NPI: 1235260407 LIC: DN14972
CERTIFICATIONS :
#021831
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Coral Springs Family
Orthodontics
1881 N University Drive, Ste 208
Pompano Beach, FL 33071
(954) 393-0303
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
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
English, Spanish, Creoles and Pidgins,
French-based(other)
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
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
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
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 :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
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
English, Spanish
M-T 9am-5pm
W-F 9am-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 :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
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
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
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
English, Spanish, Persian
M-T 9am-5pm
W-F 9am-5pm
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(954) 467-4705
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
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
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
#006661
Dr. Michael Barnard, DDS PA &
Assoc
1209 W. Broward Blvd
Ft Lauderdale, FL 33312
www.browarddds.com
(954) 763-3358
French, Russian, Creoles and Pidgins,
English-based(other), Spanish
T 7am - 5pm
W 8am-5pm, Th 7am-5pm,F 7am-6pm
# DN9973 Barnard, Michael
NPI: 1487752861 LIC: DN9973
CERTIFICATIONS :
# DN23257 Shippee, Rebecca
NPI: 1841778164 LIC: DN23257
CERTIFICATIONS :
#007988
Exclusive Dental Care Group, Inc.
1724 N. University Dr
Pembroke Pines, FL 33024
(954) 432-8000
Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN13937 Figueroa, Celia
NPI: 1497962658 LIC: DN13937
CERTIFICATIONS :
#010038
Family Dental Care
1600 N. State Rd 7, Ste 400
Lauderhill, FL 33313
(954) 581-9228
Portuguese, English, Spanish
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
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
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 :
# DN21226 Santana, David
NPI: 1700266657 LIC: DN21226
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
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
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
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 :
# DN21452 Vasilaros, Marina
NPI: 1588042758 LIC: DN21452
CERTIFICATIONS :
#010861
Great Expressions Dental Centers
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
2905 Sw 160Th Ave
Miramar, FL 33027
(954) 392-7051
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
English, Spanish, French
M-T 8am-5pm
W-F 8am-5pm
S 8am - 12pm
# DN20006 Arocha, Miguelina
NPI: 1407081540 LIC: DN20006
CERTIFICATIONS :
#010870
Great Expressions Dental Centers
4537 Weston Road
Weston, FL 33331
(954) 349-1289
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
English, Spanish
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 9am - 1pm
# DN21396 Dagan, Shachar
NPI: 1447632542 LIC: DN21396
CERTIFICATIONS :
# DN21006 Garcia, Luisa
NPI: 1740614163 LIC: DN21006
CERTIFICATIONS :
• Inhalation Sedation
#017850
Great Smiles Dental of Fort
Lauderdale
2633 E. Commercial Blvd Ste B
Fort Lauderdale, FL 33308
(954) 530-5352
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
English, Spanish
M 11am - 7pm, T 7am - 3pm
W 7am-3pm, Th 11am-7pm,F
7am-3pm
# DN18753 Daneshpajouh, Sara
NPI: 1982836003 LIC: DN18753
CERTIFICATIONS :
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
# DN23211 Walker, Lindsay
NPI: 1093238842 LIC: DN23211
CERTIFICATIONS :
#016725
Greenberg Dental & Orthodontics
7165 W. Oakland Park Blvd
Lauderhill, FL 33313
(954) 289-2393
M-T 7am-3pm
W 11am-7pm, Th 10am-6pm,F
7am-3pm
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN18753 Daneshpajouh, Sara
NPI: 1982836003 LIC: DN18753
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
#017045
Greenberg Dental & Orthodontics
6821 Taft Street
Hollywood, FL 33024
(954) 399-3826
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 :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22858 Kang, Youngjn
NPI: 1538680053 LIC: DN22858
CERTIFICATIONS :
• Inhalation Sedation
# DN22658 Laurey, Violet
NPI: 1194254789 LIC: DN22658
CERTIFICATIONS :
• Inhalation Sedation
# DN24103 Neyra, Arlet*
NPI: 1730747833 LIC: DN24103
CERTIFICATIONS :
# DN22862 Patel, Mitul
NPI: 1679094197 LIC: DN22862
CERTIFICATIONS :
# DN20239 Phan, Christine
NPI: 1871933846 LIC: DN20239
CERTIFICATIONS :
• Inhalation Sedation
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#017408
Greenberg Dental & Orthodontics
5443 W. Atlantic Blvd
Margate, FL 33063
(954) 947-8765
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 :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
#017046
Greenberg Dental & Orthodontics,
PA
8688 Griffin Road
Fort Lauderdale, FL 33328
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(954) 399-7814
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 :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22858 Kang, Youngjn
NPI: 1538680053 LIC: DN22858
CERTIFICATIONS :
• Inhalation Sedation
# DN22658 Laurey, Violet
NPI: 1194254789 LIC: DN22658
CERTIFICATIONS :
• Inhalation Sedation
# DN24103 Neyra, Arlet*
NPI: 1730747833 LIC: DN24103
CERTIFICATIONS :
# DN22862 Patel, Mitul
NPI: 1679094197 LIC: DN22862
CERTIFICATIONS :
# DN20239 Phan, Christine
NPI: 1871933846 LIC: DN20239
CERTIFICATIONS :
• Inhalation Sedation
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#021445
James Kerns DMD PLLC
6905 W. Broward Blvd. Ste 101
Plantation, FL 33317
smiledesigndentalpl.com
(954) 641-0414
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
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
#016230
Kid's Dental Place
333 Nw 70Th Ave #101
Plantation, FL 33317
kidsdentalfl.com
(954) 472-3118
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
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
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
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
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
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
English, Spanish, Portuguese
M-T 8am-5pm
W-Th 8am-5pm
# 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 :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
• Inhalation Sedation
#010345
NSU- BGMC Oral & Maxillofacial
Surgery
1600 S. Andrews Ave, 3Rd Floor
Fort Lauderdale, FL 33316
(954) 355-5703
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 :
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#010341
NSU- JDCH Center for
Cranio-Facial Pediatric & Dental
Care
3501 Johnson Street, Ste 200
Hollywood, FL 33021
(954) 262-2187
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13419 Ede-Nichols, Diane
NPI: 1225145683 LIC: DN13419
CERTIFICATIONS :
# DN22197 Khatib, Adel
NPI: 1235582503 LIC: DN22197
CERTIFICATIONS :
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#010346
NSU- Pediatric Dental Care
Center @ Kids
819 Ne 26Th St, Ste C
Wilton Manors, FL 33305
(954) 262-1751
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#018790
Oral 1 Dental Group
7153 N Pine Island Rd
Fort Lauderdale, FL 33321
(954) 532-3247
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
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 :
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#017867
Pembroke Miro Dental Office
7071 Taft Street
Hollywood, FL 33024
(954) 436-7699
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
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
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
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 :
# DN17761 Valdman, Vadim
NPI: 1184860413 LIC: DN17761
CERTIFICATIONS :
• Inhalation Sedation
#015501
Premier Dental Center PA
7160 Pembroke Rd
Miramar, FL 33023
(954) 987-6977
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
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
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 10 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN19079 Fernandez-Martinez,
Mariangel
NPI: 1376857441 LIC: DN19079
CERTIFICATIONS :
# DN20478 Green, Beverly
NPI: 1558704122 LIC: DN20478
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
# DN19079 Fernandez-Martinez,
Mariangel
NPI: 1376857441 LIC: DN19079
CERTIFICATIONS :
# DN20478 Green, Beverly
NPI: 1558704122 LIC: DN20478
CERTIFICATIONS :
• Inhalation Sedation
# 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
Russian, Spanish, Creoles and
Pidgins, French-based(other)
M-T 10am-9pm
W-F 10am-9pm
S 10am - 6pm
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
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 :
# DN12167 Kuntsmann, Vivian
NPI: 1104995539 LIC: DN12167
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
# 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
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
# DN20475 Santiago, Germaine
NPI: 1922341460 LIC: DN20475
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
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
English, Arabic, Farsi, Persian,
Spanish, Turkish
M 9am - 5pm, T 9am - 7pm
W 9am-5pm, Th 9am-7pm
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN19577 Green, Dory
NPI: 1538459409 LIC: DN19577
CERTIFICATIONS :
#010564
Smile Solutions Dental Group
294 Nw 172Nd Ave
Hollywood, FL 33029
(954) 432-3655
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
• Inhalation Sedation
#016630
Soto & Castillo Dental Care Inc
3911 Hollywood Blvd, Ste 102
Hollywood, FL 33021
(954) 987-3344
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
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
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-5pm
W-Th 8am-5pm
# DN16198 Orpahnos, Nancy
NPI: 1497893028 LIC: DN16198
CERTIFICATIONS :
#007578
Sunshine Dental
1711 Hammondville Road
Pompano Beach, FL 33069
(954) 972-6066
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
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
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
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
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
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
NPI: 1629296793 LIC: DN14801
CERTIFICATIONS :
ENDODONTICS
#013821
Gateway Dental Inc
6720 Pines Blvd.
Pembroke Pines, FL 33024
(305) 856-2300
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
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
English, Spanish
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
English, Spanish
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Hollywood, FL 33021
(954) 262-2187
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 :
#009139
Pembroke Dental Associates
12251 Taft St, Ste 404
Pembroke Pines, FL 33026
(954) 432-7077
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
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 :
#018617
Radwan Endodontics PLLC
6115 Stirling Rd Ste 213
Davie, FL 33314
(954) 791-3277
Arabic, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21608 Radwan, Amr
NPI: 1346687563 LIC: DN21608
CERTIFICATIONS :
#011252
Sage Dental Group of Ft
Lauderdale
6171 N. Federal Hwy
Fort Lauderdale, FL 33308
(954) 641-5610
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
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
# DN20550 Gankin, Mikhail
NPI: 1114112935 LIC: DN20550
CERTIFICATIONS :
ORAL SURGEON
#010848
Great Expressions Dental Centers
4660 W Hillsboro Blvd, Ste 7
Coconut Creek, FL 33073
(954) 428-1803
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
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
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
English, Spanish
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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN16630 Patel, Nishul
NPI: 1952558439 LIC: DN16630
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
ORTHODONTIST
#016880
Allure Dental PLLC
4267 W. Commerical Blvd
Tamarac, FL 33319
(954) 677-3202
English, Russian, French, Spanish
M-T 9am-5pm
Th-F 9am-5pm
S 9am - 3pm
# DN19915 Naghavi, Nona
NPI: 1649318262 LIC: DN19915
CERTIFICATIONS :
#015849
Castaneda Orthodontics
5558 S. Flamingo Rd, Ste 43
Cooper City, FL 33330
castanedaorthodontics.com
(954) 434-3043
English, Spanish
M 10am - 6pm, T 7am - 4pm
W 10am-6pm, Th 7am-4pm
# DN19707 Castaneda-Medina,
Zulma
NPI: 1710234463 LIC: DN19707
CERTIFICATIONS :
#019202
Cooper Orthodontics
4570 Lyons Road
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Coconut Creek, FL 33073
(954) 977-9477
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
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
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 :
#021614
Lauderdale Dentistry For Kids
LLC
4500 N State Road 7, Ste 101
Fort Lauderdale, FL 33319
(954) 261-7551
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
(954) 719-7955
English, Russian
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
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 :
#007926
Pediatric Dental Centers of
Broward
8351 W. Atlantic Blvd
Coral Springs, FL 33071
(954) 341-0002
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 2pm
# DN13470 Ramos, Gisleda
NPI: 1437204765 LIC: DN13470
CERTIFICATIONS :
#022347
Shaun L. Smith DDS PLLC
8223 W. Atlantic Blvd
Pompano Beach, FL 33071
(954) 368-0105
English, Spanish
M 10am - 6pm, T 9am - 5pm
W 10am-6pm, Th 9am-5pm
# DN23095 Smith, Shaun
NPI: 1932499217 LIC: DN23095
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#013763
A & B Pediatric Dentists
6370 N. State Rd 7 Ste 115
Coconut Creek, FL 33073
(954) 866-4223
English, Spanish, Portuguese
M 8am - 5pm, T 9am - 5pm
W 9am-5pm, Th 8am-5pm
# 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
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
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
#011659
American Pediatric Dental Group
10021 Pines Blvd Ste 100
Pembroke Pines, FL 33024
(954) 417-1337
English
M 9am - 5pm, T 8am - 5pm
W 8am-5pm, Th 9am-5pm,F 8am-5pm
S 8am - 2pm
# DN18730 Aza, Sara
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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 :
# 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
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 :
# 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
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
# 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
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
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
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
English, Spanish
M-T 8am-8pm
W 8am-8pm, Th 9am-8pm,F 8am-5pm
S 8am - 5pm
# DN21814 Criscuolo, Stephen
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
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
(954) 753-7770
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
English, Spanish, Creoles and Pidgins,
French-based(other), Portuguese
M-T 8am-5pm
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
English
M-T 8am-5pm
W-F 8am-5pm
# DN20210 Abarca, Marvin
NPI: 1316388820 LIC: DN20210
CERTIFICATIONS :
• Inhalation Sedation
#010865
Great Expressions Dental Centers
140 South University Drive
Pembroke Pines, FL 33025
(954) 431-0004
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
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
English, Spanish
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
#022886
Izzy Kidz Dentistry
2323 Ne 26Th Ave, Ste 107
Pompano Beach, FL 33062
(954) 406-8800
English
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
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
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
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 :
#010179
Journey Kids Dental
2022 Ne 18Th Street
Ft Lauderdale, FL 33305
(954) 727-9865
English, Spanish
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(954) 300-3002
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
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
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
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
#013365
Lakes Mall Dental Center, PA
11401 Pines Blvd, Ste 220
Pembroke Pines, FL 33026
(954) 432-5515
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
(954) 859-5551
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
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
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
#011306
Main Street Children's Dentistry
of South Broward
9900 Stirling Road, Ste 100
Cooper City, FL 33024
(954) 432-8707
English, Spanish
M-T 9am-5pm
W 8am-4pm, Th 9am-5pm,F 8am-4pm
# DN20210 Abarca, Marvin
NPI: 1316388820 LIC: DN20210
CERTIFICATIONS :
• Inhalation Sedation
#016573
Mini Mouths Dentistry
700 N. Hiatus Rd Ste 101
Pembroke Pines, FL 33026
www.minimouths.com
(754) 217-4633
English, Spanish, Portuguese
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
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
English, Spanish
M 1pm - 5pm,
W-F 9am-5pm
# 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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN4823 Arnold Jr., Dan
NPI: 1275644668 LIC: DN4823
CERTIFICATIONS :
• Inhalation Sedation
# DTP643 Chin, Judith
NPI: 1124151592 LIC: DTP643
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 17 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
• Board Certification
• Inhalation Sedation
# DTP648 Kim, Margaret
NPI: 1649292103 LIC: DTP648
CERTIFICATIONS :
• Inhalation Sedation
# DTP259 Larumbe, Jose
NPI: 1972605038 LIC: DTP259
CERTIFICATIONS :
• Inhalation Sedation
# DTP526 Noguera, Alberto
NPI: 1619206752 LIC: DTP526
CERTIFICATIONS :
• Inhalation 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
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN4823 Arnold Jr., Dan
NPI: 1275644668 LIC: DN4823
CERTIFICATIONS :
• Inhalation Sedation
# DTP648 Kim, Margaret
NPI: 1649292103 LIC: DTP648
CERTIFICATIONS :
• Inhalation Sedation
#020830
Patricia Gonzalez Templeton,
DDS, LLC
2249 N University Dr.
Pembroke Pnes, FL 33024
www.smileprotector.com
(954) 983-1680
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
8351 W. Atlantic Blvd
Coral Springs, FL 33071
(954) 341-0002
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
# 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
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
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
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
#015848
Smile Everyday Plantation
7500 Nw 5Th Street, Ste 107
Plantation, FL 33317
(954) 682-8000
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
• Inhalation Sedation
#015576
Sunshine Pediatric Dentistry
5000 Hollywood Blvd, Ste 1
Hollywood, FL 33021
(954) 989-4400
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
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
#017011
Super Smiles Pediatric Dentistry
& Orthodontics
1670 N. University Dr Ste B
Coral Springs, FL 33071
(954) 346-8108
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
#007556
Tiki Dental
501 Golden Isles Dr., Ste 202
Hallandale, FL 33009
(954) 889-8889
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
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
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
#010649
Plantation Dental Services, P.A.
314 S. University Drive
Plantation, FL 33324
(954) 474-8475
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17440 Oliver, Francisco
NPI: 1437316510 LIC: DN17440
CERTIFICATIONS :
CALHOUN COUNTY
DENTIST
#016515
Layne & Barth Family Dentistry,
P.A.
19606 State Road 20 W
Blountstown, FL 32424
www.laynefamilydentistry.com
(850) 674-5502
English
M-T 8am-5pm
W-Th 8am-5pm
# DN19827 Barth, Nicholas
NPI: 1396090320 LIC: DN19827
CERTIFICATIONS :
• Inhalation Sedation
CHARLOTTE COUNTY
DENTIST
#CHC011905
DOH - Charlotte County Health
Department
1100 Loveland Blvd
Port Charlotte, FL 33980
(941) 624-7200
English
M-T 8am-5pm
W-F 8am-5pm
# HAD79 Cocchieri, Richard
NPI: 1578685491 LIC: HAD79
CERTIFICATIONS :
# HAD100 Miles, Kenneth
NPI: 1063563724 LIC: HAD100
CERTIFICATIONS :
#FQHC010645
Family Health Centers of
Southwest Florida, Inc.
4300 Kings Hwy, Ste #500
Port Charlotte, FL 33980
(239) 344-2337
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17266 Natali, Anabel
NPI: 1386606127 LIC: DN17266
CERTIFICATIONS :
• Inhalation Sedation
CITRUS COUNTY
DENTIST
#022662
Citrus Springs Dental Care PLLC
9535 N Citrus Springs Blvd
Citrus Springs, FL 34434
(352) 465-3008
English
M-T 8am-4pm
W 8am-7pm,
# DN19041 Chapagain, Shweta
NPI: 1346561396 LIC: DN19041
CERTIFICATIONS :
• Inhalation Sedation
#FQHC016660
Langley Health Services
314 S. Line Ave
Inverness, FL 34452
(352) 419-4056
English
M-T 8am-5pm
W-F 8am-5pm
# DN23356 Lutes, Meaghan
NPI: 1760974554 LIC: DN23356
CERTIFICATIONS :
# DN17030 Sykes, Daniel
NPI: 1528273703 LIC: DN17030
CERTIFICATIONS :
# DN13460 Tutay, John
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1043413180 LIC: DN13460
CERTIFICATIONS :
CLAY COUNTY
DENTIST
#010854
Great Expressions Dental Centers
1605-110 County Road 220
Fleming Island, FL 32003
(904) 215-3533
English, Russian, Sign Languages,
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21266 Moore, Kristen
NPI: 1376926154 LIC: DN21266
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
English, Spanish, Tagalog
M 10am - 6pm, T 9am - 5pm
W-F 7am-3pm
S 8am - 1pm
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M 10am - 6pm, T 8am - 4pm
W 10am-6pm, Th 8am-4pm,F
7am-3pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN22048 Dubey, Akhil
NPI: 1982057444 LIC: DN22048
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# DN20877 Zariffard, Ehsan
NPI: 1528458932 LIC: DN20877
CERTIFICATIONS :
• Inhalation Sedation
#020600
Greenberg Dental & Orthodontics
2710 Blanding Blvd Ste 3
Middleburg, FL 32068
(904) 637-1148
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
# DN19067 Antony, Kathryn
NPI: 1811209059 LIC: DN19067
CERTIFICATIONS :
• Inhalation Sedation
# DN21311 Barbela, Antal
NPI: 1508247313 LIC: DN21311
CERTIFICATIONS :
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN18368 Bennett, James
NPI: 1659587715 LIC: DN18368
CERTIFICATIONS :
# DN20398 Burgess Chaves,
Stephanie
NPI: 1144655143 LIC: DN20398
CERTIFICATIONS :
# DN19373 Carter, Ben
NPI: 1851679666 LIC: DN19373
CERTIFICATIONS :
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN21460 Garcia, Emily
NPI: 1932584745 LIC: DN21460
CERTIFICATIONS :
• Inhalation Sedation
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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 :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN19365 Hasona, Adnan
NPI: 1881980928 LIC: DN19365
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22205 Lidhran, Paraminderpal
NPI: 1609322270 LIC: DN22205
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
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 :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
#014119
Greenberg Dental & Orthodontics
PA
1985 Eastwest Pkwy
Fleming Island, FL 32003
(904) 639-6091
English, Spanish
M-T 7am-3pm
Th-F 7am-3pm
# DN23698 Asadi, Siraj
NPI: 1235612730 LIC: DN23698
CERTIFICATIONS :
# DN21311 Barbela, Antal
NPI: 1508247313 LIC: DN21311
CERTIFICATIONS :
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN18368 Bennett, James
NPI: 1659587715 LIC: DN18368
CERTIFICATIONS :
# DN20398 Burgess Chaves,
Stephanie
NPI: 1144655143 LIC: DN20398
CERTIFICATIONS :
# DN19373 Carter, Ben
NPI: 1851679666 LIC: DN19373
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 :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN21460 Garcia, Emily
NPI: 1932584745 LIC: DN21460
CERTIFICATIONS :
• Inhalation Sedation
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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 :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN19365 Hasona, Adnan
NPI: 1881980928 LIC: DN19365
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22205 Lidhran, Paraminderpal
NPI: 1609322270 LIC: DN22205
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21362 Poblenz, Charles
NPI: 1134501141 LIC: DN21362
CERTIFICATIONS :
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
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 :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# DN20877 Zariffard, Ehsan
NPI: 1528458932 LIC: DN20877
CERTIFICATIONS :
• Inhalation Sedation
ENDODONTICS
#019277
Dr. Michael R. Smith D.M.D. PA
1520 Business Center Dr. #2
Orange Park, FL 32003
(904) 637-0028
English, Spanish
M-T 7am-4pm
W-Th 7am-4pm
# DN13788 Smith, Michael
NPI: 1285764860 LIC: DN13788
CERTIFICATIONS :
• Inhalation Sedation
#020600
Greenberg Dental & Orthodontics
2710 Blanding Blvd Ste 3
Middleburg, FL 32068
(904) 637-1148
English, Spanish
M 7am - 3pm, T 10am - 6pm
W 7am-3pm, Th 10am-6pm,F
7am-3pm
S 7am - 2pm
# DN18183 Marcos-Arenal, Jose
NPI: 1518143775 LIC: DN18183
CERTIFICATIONS :
#014119
Greenberg Dental & Orthodontics
PA
1985 Eastwest Pkwy
Fleming Island, FL 32003
(904) 639-6091
English, Spanish
M-T 7am-3pm
Th-F 7am-3pm
# DN18183 Marcos-Arenal, Jose
NPI: 1518143775 LIC: DN18183
CERTIFICATIONS :
ORAL SURGEON
#020600
Greenberg Dental & Orthodontics
2710 Blanding Blvd Ste 3
Middleburg, FL 32068
(904) 637-1148
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#014119
Greenberg Dental & Orthodontics
PA
1985 Eastwest Pkwy
Fleming Island, FL 32003
(904) 639-6091
English, Spanish
M-T 7am-3pm
Th-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
#018291
Imray & Gesek DMD PA
1409 Kingsley Ave Ste 5
Orange Park, FL 32073
(904) 264-7383
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
#020600
Greenberg Dental & Orthodontics
2710 Blanding Blvd Ste 3
Middleburg, FL 32068
(904) 637-1148
English, Spanish
M 7am - 3pm, T 10am - 6pm
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
English, Russian, Sign Languages,
Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN18619 Kuhl, Philip
NPI: 1265668586 LIC: DN18619
CERTIFICATIONS :
• Inhalation Sedation
# DN20924 Sipe, Anna
NPI: 1750588182 LIC: DN20924
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#020600
Greenberg Dental & Orthodontics
2710 Blanding Blvd Ste 3
Middleburg, FL 32068
(904) 637-1148
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
PA
1985 Eastwest Pkwy
Fleming Island, FL 32003
(904) 639-6091
English, Spanish
M-T 7am-3pm
Th-F 7am-3pm
# DN21662 Adibi, Farnaz
NPI: 1902242431 LIC: DN21662
CERTIFICATIONS :
• Inhalation Sedation
# DN20583 Gabler, Heather
NPI: 1588919724 LIC: DN20583
CERTIFICATIONS :
• Inhalation Sedation
PERIODONTICS
#020600
Greenberg Dental & Orthodontics
2710 Blanding Blvd Ste 3
Middleburg, FL 32068
(904) 637-1148
English, Spanish
M 7am - 3pm, T 10am - 6pm
W 7am-3pm, Th 10am-6pm,F
7am-3pm
S 7am - 2pm
# 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
PA
1985 Eastwest Pkwy
Fleming Island, FL 32003
(904) 639-6091
English, Spanish
M-T 7am-3pm
Th-F 7am-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
COLLIER COUNTY
DENTIST
#CHC015257
DOH - Collier County Health
Department
3339 East Tamiami Trail, Ste 145
Naples, FL 34106
(239) 252-5314
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 :
#011001
Great Expressions Dental Centers
5022 Airport Pulling Road North,
Unit 22
Naples, FL 34105
(239) 649-0598
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 :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#FQHC013671
Healthcare Network of SW FL
1454 Madison Ave
Immokalee, FL 34142
(239) 658-3000
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21878 Mancera-Loftin, Julie
NPI: 1033569447 LIC: DN21878
CERTIFICATIONS :
• Inhalation Sedation
# DN22155 Ochoa, Margarita
NPI: 1376785329 LIC: DN22155
CERTIFICATIONS :
• Inhalation Sedation
# DN23447 Patalinghug, Lady
Joedeline
NPI: 1700232535 LIC: DN23447
CERTIFICATIONS :
# DN23310 Patalinghug, Ulysses
NPI: 1689020935 LIC: DN23310
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
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
# DN23771 Riggio, Anthony
NPI: 1043716996 LIC: DN23771
CERTIFICATIONS :
#FQHC014580
Healthcare Network of SW FL
4077 Tamiami Trail N
Naples, FL 34103
(239) 658-3000
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
# DN22155 Ochoa, Margarita
NPI: 1376785329 LIC: DN22155
CERTIFICATIONS :
• Inhalation Sedation
# DN23447 Patalinghug, Lady
Joedeline
NPI: 1700232535 LIC: DN23447
CERTIFICATIONS :
# DN23310 Patalinghug, Ulysses
NPI: 1689020935 LIC: DN23310
CERTIFICATIONS :
# DN23771 Riggio, Anthony
NPI: 1043716996 LIC: DN23771
CERTIFICATIONS :
#FQHC022371
Healthcare Network of SW FL
2355 Stanford Ct, Ste 701
Naples, FL 34112
(239) 658-3000
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 :
# DN23310 Patalinghug, Ulysses
NPI: 1689020935 LIC: DN23310
CERTIFICATIONS :
#014619
Northern Dental General and
Cosmetic Dentistry LLC
5651 Naples Blvd
Naples, FL 34109
(239) 431-5666
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
English, Spanish, French
M 10am - 6pm, T 9am - 6pm
W 9am-7pm, Th 9am-6pm
# DN23454 Nguyen, Michelle
NPI: 1033603733 LIC: DN23454
CERTIFICATIONS :
• Inhalation Sedation
#022815
Wisdom Dental PA
5064 Annunciation Circle, Ste 101
Ave Maria, FL 34142
(239) 919-6930
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21551 Akpaka, Wisdom
NPI: 1114338738 LIC: DN21551
CERTIFICATIONS :
ORTHODONTIST
#017214
Polo Dental of Naples
4280 Tamiami Trail East, Ste 201
Naples, FL 34112
(239) 258-0421
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# HAD98 Keck, Douglas
NPI: 1710988704 LIC: HAD98
CERTIFICATIONS :
#FQHC014580
Healthcare Network of SW FL
4077 Tamiami Trail N
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Naples, FL 34103
(239) 658-3000
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
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
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# 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
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
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
English, Farsi, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 9am - 2pm
# DN20379 Josephs, Elias
NPI: 1942511803 LIC: DN20379
CERTIFICATIONS :
• Inhalation Sedation
COLUMBIA COUNTY
DENTIST
#CHC010298
DOH - Columbia County Health
Dept -SCHOOL BASED
LOCATION
217 Ne Franklin St
Lake City, FL 32055
(386) 752-9914
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 :
#FQHC012459
Palms Dentistry
173 Nw Albritton Lane
Lake City, FL 32055
(386) 752-5904
English
M-T 8am-5pm
W-F 8am-5pm
# DN9869 Jones, Stanley
NPI: 1528162047 LIC: DN9869
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
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
English
# 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
English, Spanish
T 8am - 4pm
W-F 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 24 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN3300 Chamberlain, Norman
NPI: 1912155631 LIC: DN3300
CERTIFICATIONS :
• Inhalation Sedation
#008933
A Better Smile Denture Center
7645 Merrill Road Ste 305
Jacksonville, FL 32277
(904) 493-1005
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
English, Spanish
W 8am-4pm,
# DN20641 Makary, Sara
NPI: 1851704654 LIC: DN20641
CERTIFICATIONS :
# DN20613 Martin, Shakela
NPI: 1639582943 LIC: DN20613
CERTIFICATIONS :
#010665
Dental Place of Jax, P.A.
5800 Beach Blvd, Ste 102
Jacksonville, FL 32207
(904) 330-0630
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
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
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 :
# HAD62 Sturtz, Renate
NPI: 1922129600 LIC: HAD62
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
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 :
# HAD62 Sturtz, Renate
NPI: 1922129600 LIC: HAD62
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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 5pm
# DN20374 Gottipati, Padmalatha
NPI: 1013340405 LIC: DN20374
CERTIFICATIONS :
• Inhalation Sedation
# DN13001 Smith, Daryl
NPI: 1881704559 LIC: DN13001
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 2pm
# DN8532 Grier, Carrol
NPI: 1750335857 LIC: DN8532
CERTIFICATIONS :
• Inhalation Sedation
# DN16874 Vo, Jossette
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1699821074 LIC: DN16874
CERTIFICATIONS :
• Inhalation Sedation
#009179
Family Dentistry
1440-1 Dunn Ave
Jacksonville, FL 32218
(904) 757-2500
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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
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
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
# 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
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
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
Jacksonville, FL 32218
(904) 751-3444
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 :
# DN22809 Lopez, Karina
NPI: 1669997565 LIC: DN22809
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
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 :
# DN7977 Woodward, Wyman
NPI: 1932255320 LIC: DN7977
CERTIFICATIONS :
#011000
Great Expressions Dental Centers
9119 Merrill Road, Ste # 29 & 30
Jacksonville, FL 32225
(904) 744-7202
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 :
# 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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(904) 786-1309
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 :
# DN22875 Morrell, Adam
NPI: 1689196164 LIC: DN22875
CERTIFICATIONS :
# DN7977 Woodward, Wyman
NPI: 1932255320 LIC: DN7977
CERTIFICATIONS :
#011008
Great Expressions Dental Centers
751 Oak Street, Ste 601
Jacksonville, FL 32204
(904) 354-4031
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 :
# 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
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
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
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
# DN22875 Morrell, Adam
NPI: 1689196164 LIC: DN22875
CERTIFICATIONS :
#016229
Great Expressions Dental Centers
12420 San Jose Blvd
Jacksonville, FL 32223
(904) 268-3002
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21266 Moore, Kristen
NPI: 1376926154 LIC: DN21266
CERTIFICATIONS :
• Inhalation Sedation
#015100
Greenberg Dental - Atlantic Beach
1023 Atlantic Blvd
Atlantic Beach, FL 32233
(904) 249-3104
English, Spanish
M-T 7am-3pm
W-F 7am-3pm
S 8am - 4pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN22048 Dubey, Akhil
NPI: 1982057444 LIC: DN22048
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
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
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Russian, Spanish
M-T 7am-6pm
W 7am-7pm, Th 7am-4pm,F 7am-3pm
S 8am - 1pm
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN22077 Soni, Juhi
NPI: 1821441379 LIC: DN22077
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
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 27 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#015136
Greenberg Dental - Baymeadows
9978 Old Baymeadows Rd, Ste 1
Jacksonville, FL 32256
(904) 645-5015
English, Spanish
M 10am - 6pm, T 8am - 4pm
W-Th 8am-4pm
S 8am - 2pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# DN20877 Zariffard, Ehsan
NPI: 1528458932 LIC: DN20877
CERTIFICATIONS :
• Inhalation Sedation
#015122
Greenberg Dental - Blanding
5116 Blanding Blvd
Jacksonville, FL 32210
(904) 573-7900
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
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN24222 Shano, Ammar
NPI: 1629637871 LIC: DN24222
CERTIFICATIONS :
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
M 7am - 3pm, T 10am - 6pm
W-F 7am-3pm
S 8am - 2pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
English
M 10am - 6pm, T 8am - 4pm
W-Th 8am-4pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
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
# DN23698 Asadi, Siraj
NPI: 1235612730 LIC: DN23698
CERTIFICATIONS :
# DN21311 Barbela, Antal
NPI: 1508247313 LIC: DN21311
CERTIFICATIONS :
# DN18368 Bennett, James
NPI: 1659587715 LIC: DN18368
CERTIFICATIONS :
# DN20398 Burgess Chaves,
Stephanie
NPI: 1144655143 LIC: DN20398
CERTIFICATIONS :
# DN19373 Carter, Ben
NPI: 1851679666 LIC: DN19373
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 :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN21460 Garcia, Emily
NPI: 1932584745 LIC: DN21460
CERTIFICATIONS :
• Inhalation Sedation
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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 :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN19365 Hasona, Adnan
NPI: 1881980928 LIC: DN19365
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
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 :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21362 Poblenz, Charles
NPI: 1134501141 LIC: DN21362
CERTIFICATIONS :
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
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 :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
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
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M 10am - 6pm, T 9am - 5pm
W-Th 8am-4pm
S 8am - 2pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 29 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
• Inhalation Sedation
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
Spanish, French
M 9am - 5pm, T 8am - 4pm
W-Th 8am-4pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M 9am - 5pm, T 10am - 6pm
Th-F 7am-3pm
S 8am - 2pm
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN22048 Dubey, Akhil
NPI: 1982057444 LIC: DN22048
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN22077 Soni, Juhi
NPI: 1821441379 LIC: DN22077
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M 10am - 6pm, T 8am - 4pm
Th-F 8am-4pm
# 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 :
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN22048 Dubey, Akhil
NPI: 1982057444 LIC: DN22048
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN21460 Garcia, Emily
NPI: 1932584745 LIC: DN21460
CERTIFICATIONS :
• Inhalation Sedation
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
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 30 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# 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 :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22205 Lidhran, Paraminderpal
NPI: 1609322270 LIC: DN22205
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN21362 Poblenz, Charles
NPI: 1134501141 LIC: DN21362
CERTIFICATIONS :
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN22077 Soni, Juhi
NPI: 1821441379 LIC: DN22077
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
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
Russian, Arabic, English, Spanish
M-T 10am-7pm
W-F 10am-7pm
S 10am - 7pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
CERTIFICATIONS :
# DN22451 Gruenberg, Alex
NPI: 1255844924 LIC: DN22451
CERTIFICATIONS :
# DN22242 Guerra, Vannette
NPI: 1598184327 LIC: DN22242
CERTIFICATIONS :
# DN22389 Inaba, Caroline
NPI: 1629319249 LIC: DN22389
CERTIFICATIONS :
# DN23847 Khan, Adiba
NPI: 1649638172 LIC: DN23847
CERTIFICATIONS :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
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 :
#008995
Smith and Smith Dental
Associates
1190 West Edgewood Ave Ste B
Jacksonville, FL 32208
(904) 764-4549
English
M-T 8am-5pm
W-Th 8am-5pm
# DN14791 Smith, Alisia
NPI: 1447323076 LIC: DN14791
CERTIFICATIONS :
# DN14805 Smith, Ivan
NPI: 1942373584 LIC: DN14805
CERTIFICATIONS :
#008949
Soutel Dental Center
5475 Soutel Drive
Jacksonville, FL 32219
(904) 764-4576
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
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 :
# HAD62 Sturtz, Renate
NPI: 1922129600 LIC: HAD62
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
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
751 Oak Street, Ste 601
Jacksonville, FL 32204
(904) 354-4031
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
English
M-T 8am-5pm
W-Th 8am-5pm
# DN19363 Serrano, Eric
NPI: 1184919334 LIC: DN19363
CERTIFICATIONS :
#015101
Greenberg Dental - Northside
1036 Dunn Ave Ste 42
Jacksonville, FL 32218
(904) 714-9909
English, Spanish
M 7am - 6pm, T 7am - 5pm
W-Th 7am-6pm
S 8am - 3pm
# DN18183 Marcos-Arenal, Jose
NPI: 1518143775 LIC: DN18183
CERTIFICATIONS :
ORAL SURGEON
# 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
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
ORTHODONTIST
#015101
Greenberg Dental - Northside
1036 Dunn Ave Ste 42
Jacksonville, FL 32218
(904) 714-9909
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 :
#018489
Greenberg Dental & Orthodontics
11043 Crystal Springs Rd Ste 20
Jacksonville, FL 32221
(904) 236-6250
English, Spanish
M 10am - 6pm, T 8am - 4pm
Th-F 8am-4pm
# DN21116 Lipkin, Julia
NPI: 1225447493 LIC: DN21116
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#010846
Great Expressions Dental Centers
3706 Blanding Blvd
Jacksonville, FL 32210
(904) 777-1477
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 3pm
# DN19517 Escobedo, Carolina
NPI: 1265838494 LIC: DN19517
CERTIFICATIONS :
• Conscious Sedation
• General Anesthesia
• Inhalation Sedation
• Intravenous Sedation
• Oral / Enteral Sedation
• Parenteral Sedation
• Pediatric Conscious Sedation
# DN18619 Kuhl, Philip
NPI: 1265668586 LIC: DN18619
CERTIFICATIONS :
• Inhalation Sedation
# DN20924 Sipe, Anna
NPI: 1750588182 LIC: DN20924
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#014135
Great Expressions Dental Centers
9000 Golfside Dr Ste A
Jacksonville, FL 32256
(904) 737-8410
English
M-T 8am-5pm
W-F 8am-5pm
# DN19517 Escobedo, Carolina
NPI: 1265838494 LIC: DN19517
CERTIFICATIONS :
• Conscious Sedation
• General Anesthesia
• Inhalation Sedation
• Intravenous Sedation
• Oral / Enteral Sedation
• Parenteral Sedation
• Pediatric Conscious Sedation
# DN20924 Sipe, Anna
NPI: 1750588182 LIC: DN20924
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#015101
Greenberg Dental - Northside
1036 Dunn Ave Ste 42
Jacksonville, FL 32218
(904) 714-9909
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
#018489
Greenberg Dental & Orthodontics
11043 Crystal Springs Rd Ste 20
Jacksonville, FL 32221
(904) 236-6250
English, Spanish
M 10am - 6pm, T 8am - 4pm
Th-F 8am-4pm
# DN15103 Bennett, 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 32 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1902216153 LIC: DN15103
CERTIFICATIONS :
#011965
Kids First Dentistry
4495 Roosevelt Blvd, Ste 111
Jacksonville, FL 32210
kids1dentistry.com
(904) 423-1377
English
M-T 8am-5pm
W-Th 8am-5pm
# DN13919 Mahajan, Jila
NPI: 1780734251 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
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
#011380
Richard W. Blake DDS PA
943 Cesery Blvd, #D
Jacksonville, FL 32211
(904) 743-2000
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
#015101
Greenberg Dental - Northside
1036 Dunn Ave Ste 42
Jacksonville, FL 32218
(904) 714-9909
English, Spanish
M 7am - 6pm, T 7am - 5pm
W-Th 7am-6pm
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
#018489
Greenberg Dental & Orthodontics
11043 Crystal Springs Rd Ste 20
Jacksonville, FL 32221
(904) 236-6250
English, Spanish
M 10am - 6pm, T 8am - 4pm
Th-F 8am-4pm
# DN22055 Rosebrough, Claire
NPI: 1093266181 LIC: DN22055
CERTIFICATIONS :
# DN18109 Yeung, Victor
NPI: 1730407529 LIC: DN18109
CERTIFICATIONS :
• Board Certification
• Conscious Sedation
ESCAMBIA COUNTY
DENTIST
#013222
Cordova Dental Center
5120 Bayou Blvd, Ste #4
Pensacola, FL 32503
(850) 477-3188
English, Farsi, Vietnamese
M-T 9am-5pm
W-F 9am-5pm
# DN11910 Schildroth, Charles
NPI: 1740334655 LIC: DN11910
CERTIFICATIONS :
#FQHC014964
ECC At Cantonment Pediatrics
470 S. Hwy 29
Cantonment, FL 32533
(850) 780-0111
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 :
# DN20201 Lane, Victoria
NPI: 1295179745 LIC: DN20201
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#FQHC014990
ECC at Century Pediatrics
501 Church Street
Century, FL 32535
healthcarewithinreach.org
(850) 724-4054
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 :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#FQHC022628
ECC at Century Primary Care
6021 Industrial Blvd
Century, FL 32535
(850) 724-4064
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 :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#FQHC013509
ECC Dental Clinic
1295 W. Fairfield Dr
Pensacola, FL 32501
(850) 912-8880
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 :
# DN20201 Lane, Victoria
NPI: 1295179745 LIC: DN20201
CERTIFICATIONS :
# DN18871 Pate, Sheena
NPI: 1215255880 LIC: DN18871
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN22386 Watkins, Jacinta
NPI: 1770885436 LIC: DN22386
CERTIFICATIONS :
#022465
Victus Dental II PA
1308 West 9 Mile Road, Ste 9
Pensacola, FL 32534
(850) 484-4844
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
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
English
M-T 8am-5pm
W-F 8am-5pm
# DN18812 Fishbein, Benjamin
NPI: 1144543620 LIC: DN18812
CERTIFICATIONS :
# DN22495 Howle, Sarah
NPI: 1215477146 LIC: DN22495
CERTIFICATIONS :
#019097
Fishbein Orthodontics
12385 Sorrento Rd, Ste C2
Pensacola, FL 32507
wwwemeraldcoastbraces.com
(850) 477-1089
English
M-T 8am-5pm
W-F 8am-5pm
# DN18812 Fishbein, Benjamin
NPI: 1144543620 LIC: DN18812
CERTIFICATIONS :
# DN22495 Howle, Sarah
NPI: 1215477146 LIC: DN22495
CERTIFICATIONS :
FLAGLER COUNTY
DENTIST
#CHC10022
DOH - Flagler County Health
Department
301 Dr Carter Bvd
Bunnell, FL 32110
(386) 437-7350
English, Russian, 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
PA
50 Plaza Dr Ste 201
Palm Coast, FL 32137
(386) 516-0751
M-T 10am-6pm
W-Th 8am-4pm
S 8am - 2pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN19067 Antony, Kathryn
NPI: 1811209059 LIC: DN19067
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 :
# DN18368 Bennett, James
NPI: 1659587715 LIC: DN18368
CERTIFICATIONS :
# DN23294 Brambila, Danielle
NPI: 1720577703 LIC: DN23294
CERTIFICATIONS :
• Inhalation Sedation
# DN20398 Burgess Chaves,
Stephanie
NPI: 1144655143 LIC: DN20398
CERTIFICATIONS :
# DN19373 Carter, Ben
NPI: 1851679666 LIC: DN19373
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 :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN21460 Garcia, Emily
NPI: 1932584745 LIC: DN21460
CERTIFICATIONS :
• Inhalation Sedation
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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 :
# DN19365 Hasona, Adnan
NPI: 1881980928 LIC: DN19365
CERTIFICATIONS :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22205 Lidhran, Paraminderpal
NPI: 1609322270 LIC: DN22205
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23549 Nguyen, Linda
NPI: 1972039493 LIC: DN23549
CERTIFICATIONS :
# DN21362 Poblenz, Charles
NPI: 1134501141 LIC: DN21362
CERTIFICATIONS :
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
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 :
# DN19575 Walker, Aaron
NPI: 1932399284 LIC: DN19575
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
English
M-T 8am-4pm
W-Th 8am-4pm
# DN15035 Johnson, Mark
NPI: 1154443513 LIC: DN15035
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#017728
Greenberg Dental & Orthodontics
PA
50 Plaza Dr Ste 201
Palm Coast, FL 32137
(386) 516-0751
M-T 10am-6pm
W-Th 8am-4pm
S 8am - 2pm
# 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
FRANKLIN COUNTY
DENTIST
#FQHC015406
PanCare of Florida
106 Ne 5Th St
Carrabelle, FL 32322
(850) 215-3578
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 :
# 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 :
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
CERTIFICATIONS :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
GADSDEN COUNTY
DENTIST
#014905
Dental Workz of Quincy
314 E. Jefferson St
Quincy, FL 32351
(850) 618-0114
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 :
#FQHC015507
Jessie Furlow Medical Center
1249 Strong Rd
Quincy, FL 32351
www.northfloridamedicalcenters.org
(850) 875-9502
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
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 :
# DN19383 Garraway, Chinara
NPI: 1629364153 LIC: DN19383
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 :
GILCHRIST COUNTY
DENTIST
#CHC015359
DOH - Gilchrist County Health
Department
119 Ne 1St St
Trenton, FL 32693
(352) 463-3120
English
M-T 8am-5pm
W 8am-5pm,
# 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
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
# DN20927 Rooney, Matthew
NPI: 1598165532 LIC: DN20927
CERTIFICATIONS :
• Inhalation Sedation
GLADES COUNTY
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 35 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
DENTIST
#FQHC011249
Florida Community Health
Centers, Inc.
1021 Health Park Drive
Moore Haven, FL 33471
(863) 946-0405
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 :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
GULF COUNTY
DENTIST
#FQHC014254
PanCare of Florida
2475 Garrison Ave
Port Saint Joe, FL 32456
(850) 215-3578
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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 :
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
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
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 :
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
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
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
English, Spanish, Creoles and Pidgins,
English-based(other), French
M-T 7am-5pm
W-F 7am-5pm
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# HAD92 Coello, Marla
NPI: 1891833620 LIC: HAD92
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN18203 Geller, Robert
NPI: 1669503280 LIC: DN18203
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN18154 Mckenzie, Karen
NPI: 1821286287 LIC: DN18154
CERTIFICATIONS :
# HAD33 Modaff, Michelle
NPI: 1497768295 LIC: HAD33
CERTIFICATIONS :
# DN6990 Seifert, Thomas
NPI: 1255654232 LIC: DN6990
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#CHC10021
DOH - Hardee County Health
Department
115 K. D. Revell Road
Wauchula, FL 33873
(863) 773-4161
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
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
#FQHC010641
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Family Health Centers of
Southwest Florida, Inc.
930 S. Main St
Labelle, FL 33935
www.fhcswf.org
(863) 675-0387
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
# 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 :
# 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
English, Spanish
M 8am - 5pm, T 8am - 6pm
W-Th 8am-5pm
# DN20720 Blackwood, Alberto
NPI: 1487057303 LIC: DN20720
CERTIFICATIONS :
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN13771 Sanchez, Armando
NPI: 1992764930 LIC: DN13771
CERTIFICATIONS :
HERNANDO COUNTY
DENTIST
#011121
Akel Dental LLC
5445 Commercial Way
Spring Hill, FL 34606
(352) 596-9900
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
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
# 22DI02680600 Hernandez,
Christine
NPI: 1891216784 LIC: 22DI02680600
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
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
English, Spanish
T 7am - 4pm
# DN11556 Baker, Wayne
NPI: 1699833947 LIC: DN11556
CERTIFICATIONS :
# DN14806 Barinas-Duval, Froilan
NPI: 1699748442 LIC: DN14806
CERTIFICATIONS :
• Inhalation Sedation
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC016314
Premier Community HealthCare
Group, Inc.
7551 Forest Oaks Blvd
Spring Hill, FL 34606
(352) 518-2000
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# DN11556 Baker, Wayne
NPI: 1699833947 LIC: DN11556
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#FQHC016313
Premier Community HealthCare
Group, Inc.
300 S. Main St
Brooksville, FL 34601
(352) 518-2000
English, Spanish
T 7am - 4pm
# DN18802 Flicker, Robin
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1952531691 LIC: DN18802
CERTIFICATIONS :
• Inhalation Sedation
#010037
Smile Design Spring Hill
1406 Pinehurst Drive
Spring Hill, FL 34606
(352) 686-1007
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
Spanish, English, Creoles and Pidgins,
English-based(other), French
M-T 7am-5pm
W-F 7am-5pm
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
CERTIFICATIONS :
# DN16346 Gomara, Denise
NPI: 1497887863 LIC: DN16346
CERTIFICATIONS :
# DN22245 Rubin, Joslyn
NPI: 1861940850 LIC: DN22245
CERTIFICATIONS :
HILLSBOROUGH COUNTY
DENTIST
#013937
Akel Dental of Tampa PLLC
2727 W. Martin Luther King Jr. Ste
120
Tampa, FL 33607
(813) 873-9100
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN20318 Cisneros, Aura
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN10403 Valdez, Harvey
NPI: 1548325491 LIC: DN10403
CERTIFICATIONS :
#022643
Brandon Family Dental Care, LLC
227 N Knights Ave
Brandon, FL 33510
(813) 685-5611
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# DN11501 Parker, David
NPI: 1235255845 LIC: DN11501
CERTIFICATIONS :
#011547
Brandon Mall Dental PA
675 Brandon Town Center Mall
Brandon, FL 33511
(813) 681-8600
English, Russian, Spanish
T 10am - 4pm
W 10am-5pm, Th 10am-6pm,F
11am-6pm
S 9am - 5pm, Su 10am - 5pm
# DN17412 Atkinson, William
NPI: 1942360862 LIC: DN17412
CERTIFICATIONS :
• Inhalation Sedation
# DN22018 Pansuriya, Dharmendra
NPI: 1932645736 LIC: DN22018
CERTIFICATIONS :
#013955
Broadway Dental
5811 E. Broadway Ave
Tampa, FL 33619
www.tampabroadwaydental.com
(813) 623-1014
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
English
M-T 8am-5pm
W-Th 8am-5pm
# DN12708 Hannah-Jones, Kimberly
NPI: 1881938850 LIC: DN12708
CERTIFICATIONS :
• Inhalation Sedation
#018497
Cordica Dental Designs
520 Oakfield Dr
Brandon, FL 33511
(813) 661-1800
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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
#022656
Dental Excellence Partners, LLC
807 S. Parson Ave
Brandon, FL 33511
(813) 527-0245
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
#007673
Dr. Mukesh Kapadia
613 West Martin Luther King Bldv,
Ste #103
Tampa, FL 33603
(813) 237-2882
English, Spanish, Hindi,
Indo-European(other)
M-T 9am-5pm
Th-F 9am-5pm
S 11am - 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 38 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN10771 Kapadia, Mukesh
NPI: 1689717134 LIC: DN10771
CERTIFICATIONS :
#011410
E.L. Moore DDS, PA
6702 North Armenia Ave
Tampa, FL 33604
(813) 932-0458
English, Spanish
M-T 9am-5pm
W 9am-5pm,
S 7am - 2pm
# DN10803 Moore, Edith
NPI: 1386613578 LIC: DN10803
CERTIFICATIONS :
#011165
East Tampa Dental
4802 E. 7Th Ave
Tampa, FL 33605
(813) 248-8515
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23341 Allawnha, Abdullah
NPI: 1558852392 LIC: DN23341
CERTIFICATIONS :
# DN20636 Gagnon, Robyn
NPI: 1679986020 LIC: DN20636
CERTIFICATIONS :
# DN21361 Robbins, Jeremy
NPI: 1811370398 LIC: DN21361
CERTIFICATIONS :
# DN20669 Spouh, Mohammad
NPI: 1902210842 LIC: DN20669
CERTIFICATIONS :
#010845
Great Expressions Dental Centers
10845 Bloomingdale Ave
Riverview, FL 33578
(813) 662-6100
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN22711 Rivadeneira, Jose
NPI: 1376063313 LIC: DN22711
CERTIFICATIONS :
#010847
Great Expressions Dental Centers
15148 N. Dale Mabry Hwy
Tampa, FL 33618
(813) 960-0106
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN19709 Biandudi, Odessa
NPI: 1679835599 LIC: DN19709
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M-T 8am-5pm
W-F 7am-4pm
# DN19638 Immadi, Lakshmi
NPI: 1083988901 LIC: DN19638
CERTIFICATIONS :
#010863
Great Expressions Dental Centers
1060 West Busch Blvd, Ste 105
Tampa, FL 33612
(813) 931-4000
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN16578 Morelli, Karen
NPI: 1376758961 LIC: DN16578
CERTIFICATIONS :
#010867
Great Expressions Dental Centers
2468 W. Brandon Blvd
Brandon, FL 33511
(813) 654-6700
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN22776 Maduro, Ledesha
NPI: 1174982458 LIC: DN22776
CERTIFICATIONS :
#010869
Great Expressions Dental Centers
13022 Racetrack Rd, Ste 101
Tampa, FL 33626
(813) 814-1868
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN22306 Brattain, Andrew
NPI: 1326599168 LIC: DN22306
CERTIFICATIONS :
• Inhalation Sedation
#010984
Great Expressions Dental Centers
6552 Gunn Hwy
Tampa, FL 33625
(813) 963-0307
English, Spanish
M-T 10am-7pm
W-F 8am-5pm
# 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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN22711 Rivadeneira, Jose
NPI: 1376063313 LIC: DN22711
CERTIFICATIONS :
# DN21361 Robbins, Jeremy
NPI: 1811370398 LIC: DN21361
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
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
# DN22509 Kamdem, Elodie
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
English, Spanish
M-T 8am-5pm
W 8am-5pm, Th 8am-6pm,F 8am-5pm
# DN23932 Phu, Lesley
NPI: 1851870596 LIC: DN23932
CERTIFICATIONS :
# DN21361 Robbins, Jeremy
NPI: 1811370398 LIC: DN21361
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19709 Biandudi, Odessa
NPI: 1679835599 LIC: DN19709
CERTIFICATIONS :
• Inhalation Sedation
# DN12680 Dos Passos II, John
NPI: 1265411953 LIC: DN12680
CERTIFICATIONS :
• Inhalation Sedation
# DN17010 Howell, Dina
NPI: 1326090200 LIC: DN17010
CERTIFICATIONS :
# DN19638 Immadi, Lakshmi
NPI: 1083988901 LIC: DN19638
CERTIFICATIONS :
# 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
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
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN21267 Roque, Jose
NPI: 1093111767 LIC: DN21267
CERTIFICATIONS :
• Inhalation Sedation
#010392
Greenberg Dental & Orthodontics
2702 W. Hillsborough Ave
Tampa, FL 33614
(813) 365-3021
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 :
# DN21327 Dockus, Matthew
NPI: 1013399013 LIC: DN21327
CERTIFICATIONS :
# DN23467 Folks, Garrett
NPI: 1437643137 LIC: DN23467
CERTIFICATIONS :
• Inhalation Sedation
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN23380 Hernandez Moreno, Rosa
NPI: 1124510508 LIC: DN23380
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
# DN22832 Letteri, Nicholas
NPI: 1992237937 LIC: DN22832
CERTIFICATIONS :
# DN24441 Luong, Thinh
NPI: 1619237187 LIC: DN24441
CERTIFICATIONS :
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN23461 Musselman, Robert
NPI: 1588158505 LIC: DN23461
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
# 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
# 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 :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#010579
Greenberg Dental & Orthodontics
234 E. Bearss Ave
Tampa, FL 33613
(813) 337-6353
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish
M 10am - 6pm, T 11am - 7pm
W-Th 8am-4pm
# DN22858 Kang, Youngjn
NPI: 1538680053 LIC: DN22858
CERTIFICATIONS :
• Inhalation Sedation
#015210
Greenberg Dental & Orthodontics
8851 N. 56Th St
Temple Terrace, FL 33617
(813) 381-5628
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 :
# DN21327 Dockus, Matthew
NPI: 1013399013 LIC: DN21327
CERTIFICATIONS :
# DN23467 Folks, Garrett
NPI: 1437643137 LIC: DN23467
CERTIFICATIONS :
• Inhalation Sedation
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN23380 Hernandez Moreno, Rosa
NPI: 1124510508 LIC: DN23380
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
# DN22832 Letteri, Nicholas
NPI: 1992237937 LIC: DN22832
CERTIFICATIONS :
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
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
# 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
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# DN24318 Treyz, Carl
NPI: 1679133276 LIC: DN24318
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
# DN20156 Van, Phu
NPI: 1982043451 LIC: DN20156
CERTIFICATIONS :
#015441
Greenberg Dental & Orthodontics
12030 Anderson Rd
Tampa, FL 33625
(813) 381-5646
Spanish
M 7am - 3pm, T 11am - 7pm
W 11am-7pm, Th 7am-3pm,F
7am-2pm
# DN22132 Bacchelli, Lara
NPI: 1740633718 LIC: DN22132
CERTIFICATIONS :
# DN24190 Munro, Matthew
NPI: 1174182091 LIC: DN24190
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# DN24098 Wild, Caitlin
NPI: 1912566142 LIC: DN24098
CERTIFICATIONS :
#021732
Greenberg Dental & Orthodontics
111 W. Alexander Street
Plant City, FL 33563
(813) 708-6732
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 :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN23390 Hong, Hetty
NPI: 1659863678 LIC: DN23390
CERTIFICATIONS :
# DN22824 Jauch, Michael
NPI: 1396268504 LIC: DN22824
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
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN20239 Phan, Christine
NPI: 1871933846 LIC: DN20239
CERTIFICATIONS :
• Inhalation Sedation
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# DN24318 Treyz, Carl
NPI: 1679133276 LIC: DN24318
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#012052
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Greenberg Dental & Orthodontics
PA
10041 W. Hillsborough Ave
Tampa, FL 33615
(813) 235-0957
English, Spanish
M-T 8am-4pm
W-Th 10am-6pm
S 7am - 2pm
# DN23128 Patel, Anisha
NPI: 1124535885 LIC: DN23128
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#015277
Greenberg Dental- Brandon
511 W. Brandon Blvd
Brandon, FL 33511
(813) 381-5632
Spanish
M 10am - 6pm, T 8am - 4pm
W 10am-6pm, Th 8am-4pm,F
7am-3pm
S 8am - 3pm
# DN22365 Karapasha, Christopher
NPI: 1538601455 LIC: DN22365
CERTIFICATIONS :
• Inhalation Sedation
#018023
Happy Family Dental Group, Inc
510 Westbrook Ave
Brandon, FL 33511
(813) 651-0165
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
# 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
English, Spanish, Creoles and Pidgins
(other)
M-T 9am-4pm
W-Th 9am-4pm
# DN18899 Botero, Catalina
NPI: 1659513380 LIC: DN18899
CERTIFICATIONS :
• Inhalation Sedation
#014308
Juan L. Alvarez DDS PA
11758 Dr Martin Luther King Jr Blvd
E
Seffner, FL 33584
(813) 651-9411
English, Spanish
M-T 8am-5pm
F 8am-4pm
# DN18618 Alvarez, Juan
NPI: 1831326974 LIC: DN18618
CERTIFICATIONS :
• Inhalation Sedation
#011149
Keystone Dental Excellence
8325 Gunn Hwy
Tampa, FL 33626
(813) 792-0041
English, Spanish
M-T 7am-4pm
W-Th 7am-4pm
# DN15969 Reinhart, Joel
NPI: 1033208392 LIC: DN15969
CERTIFICATIONS :
• Inhalation Sedation
#011224
KidZone Dentistry
13039 Summerfield Square Drive
Riverview, FL 33578
(813) 677-3047
English, Arabic, French, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN18156 Garcia, Eric
NPI: 1952566341 LIC: DN18156
CERTIFICATIONS :
• Inhalation Sedation
#FQHC010979
Palm River Community Health
Center
7728 Palm River Rd
Tampa, FL 33619
(813) 630-3635
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15132 Dietz, Rodney
NPI: 1629326277 LIC: DN15132
CERTIFICATIONS :
#011089
Pedro A. Belaunzaran, DDS. P.A.
& Assc.
8130 W. Waters Ave, Ste 200-B
Tampa, FL 33615
(813) 243-4142
English, Arabic
M-T 9am-5pm
W-F 9am-5pm
# DN13554 Belaunzaran, Pedro
NPI: 1164513610 LIC: DN13554
CERTIFICATIONS :
#FQHC010829
Ruskin Health Center
2814 14Th Ave Se
Ruskin, FL 33570
(813) 653-6100
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN20318 Cisneros, Aura
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN16317 Dinh, Lan
NPI: 1568769008 LIC: DN16317
CERTIFICATIONS :
#014571
Sergio M. Lopez, DDS PLLC
3102 W. Waters Ave, Ste 101
Tampa, FL 33614
(813) 374-2441
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN18229 Lopez, Sergio
NPI: 1265441125 LIC: DN18229
CERTIFICATIONS :
#014286
Skylight Dental Care PLLC
117 N. Oakwood Ave
Brandon, FL 33510
(813) 530-0991
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
English
M-T 8am-5pm
W-F 8am-5pm
# DN20318 Cisneros, Aura
NPI: 1356346340 LIC: DN20318
CERTIFICATIONS :
• Inhalation Sedation
# DN10403 Valdez, Harvey
NPI: 1548325491 LIC: DN10403
CERTIFICATIONS :
#FQHC010697
Tampa Family Health Centers
5611 Sheldon Rd
Tampa, FL 33615
(813) 397-5300
English, Spanish, French (T)
M-T 8am-5pm
W-F 8am-5pm
# DN13067 Gamble, Isolda
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
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
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 :
# HAD95 Lara, Julio
NPI: 1114454915 LIC: HAD95
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
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
M-T 8am-5pm
W-F 8am-5pm
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
#FQHC012070
Tampa Family Health Centers,
Inc.
302 W. Fletcher Ave
Tampa, FL 33612
tampafamilyhc.com
(813) 397-5305
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN23286 Joseph, Jobin
NPI: 1669883856 LIC: DN23286
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
#FQHC10200
Tampa Family Health Centers,
Inc.
4620 N. 22Nd St
Tampa, FL 33610
tampafamilyhc.com
(813) 397-5300
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
S 8am - 1pm
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
#FQHC10202
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Tampa Family Health Centers,
Inc.
1502 E. Fowler Ave
Tampa, FL 33612
tampafamilyhc.com
(813) 397-5300
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
CERTIFICATIONS :
# DN24498 Popek, Barbara
NPI: 1740320993 LIC: DN24498
CERTIFICATIONS :
# DN22607 Rotaru, Ion
NPI: 1558899658 LIC: DN22607
CERTIFICATIONS :
#FQHC10203
Tampa Family Health Centers,
Inc.
3901 S. West Shore Blvd
Tampa, FL 33611
(813) 397-5300
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13067 Gamble, Isolda
NPI: 1992764484 LIC: DN13067
CERTIFICATIONS :
# DN4964 Graddy, Nathan
NPI: 1225318025 LIC: DN4964
CERTIFICATIONS :
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# DN23805 Najafi, Gina
NPI: 1699259291 LIC: DN23805
CERTIFICATIONS :
# DN24080 Ogunbameru, Aderonke
NPI: 1962827196 LIC: DN24080
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19926 Guerra, William
NPI: 1861749459 LIC: DN19926
CERTIFICATIONS :
# DN20612 Jean, Darlene
NPI: 1528474822 LIC: DN20612
CERTIFICATIONS :
# DN17431 Leon, Ana
NPI: 1578762332 LIC: DN17431
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15930 Barlow, Kathleen
NPI: 1164536678 LIC: DN15930
CERTIFICATIONS :
# HAD70 Simeoni, Anna
NPI: 1396817797 LIC: HAD70
CERTIFICATIONS :
#011111
Westwood Family Dental Center
8573 W. Linebaugh Ave
Tampa, FL 33625
www.westwooddentalspa.com
(813) 852-2007
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
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
English
T 9am - 3pm
# DN13140 Oguntebi, Bamiduro
NPI: 1942434642 LIC: DN13140
CERTIFICATIONS :
#014640
Endodontic Innovations
13127 Kings Lake Dr, 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 44 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Gibsonton, FL 33534
(813) 284-7958
English, Spanish, Vietnamese
M-T 9am-5pm
W-Th 9am-5pm
# DN18558 Pham, Thai
NPI: 1215261581 LIC: DN18558
CERTIFICATIONS :
• Inhalation Sedation
#010392
Greenberg Dental & Orthodontics
2702 W. Hillsborough Ave
Tampa, FL 33614
(813) 365-3021
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN17729 Sainsbury, James
NPI: 1235342650 LIC: DN17729
CERTIFICATIONS :
ORAL SURGEON
#020259
Dr. Robert Orta D.D.S., P.A
801 W. Dr. Martin Luther Kingjr.
Blvd.
Tampa, FL 33603
(813) 238-0411
English
M-T 8am-5pm
W-F 8am-5pm
# DN14351 Orta, Robert
NPI: 1376681791 LIC: DN14351
CERTIFICATIONS :
• Inhalation Sedation
#010392
Greenberg Dental & Orthodontics
2702 W. Hillsborough Ave
Tampa, FL 33614
(813) 365-3021
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# DN19281 Guerra-Andrade, Andres
NPI: 1669610044 LIC: DN19281
CERTIFICATIONS :
• General Anesthesia
# 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
Spanish, Portuguese
M-T 7am-4pm
W-Th 10am-6pm
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# DN19281 Guerra-Andrade, Andres
NPI: 1669610044 LIC: DN19281
CERTIFICATIONS :
• General Anesthesia
# DN16923 Lawson, Scott
NPI: 1467470781 LIC: DN16923
CERTIFICATIONS :
• Board Certification
• General Anesthesia
• Inhalation Sedation
#FQHC010979
Palm River Community Health
Center
7728 Palm River Rd
Tampa, FL 33619
(813) 630-3635
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19281 Guerra-Andrade, Andres
NPI: 1669610044 LIC: DN19281
CERTIFICATIONS :
• General Anesthesia
#009954
Tampa Bay Institute of Oral
Surgery & Dental Implants
7720 W. Waters Ave
Tampa, FL 33615
www.tampabayos.com
(813) 885-6555
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
English, Spanish
M-T 8am-5pm
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21728 Cetta, Christopher
NPI: 1689893240 LIC: DN21728
CERTIFICATIONS :
#015931
Florida Orthodontic Associates
1773 W. Fletcher Ave
Tampa, FL 33612
(813) 968-2483
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
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
English, Chinese Mandarin, Spanish
T 8am - 5pm
W 8am-5pm,
# DN11575 Chin, Leo
NPI: 1174731657 LIC: DN11575
CERTIFICATIONS :
• Board Certification
#010392
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 45 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
2702 W. Hillsborough Ave
Tampa, FL 33614
(813) 365-3021
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN22319 Hasan, Shadiya
NPI: 1376033654 LIC: DN22319
CERTIFICATIONS :
#015210
Greenberg Dental & Orthodontics
8851 N. 56Th St
Temple Terrace, FL 33617
(813) 381-5628
Spanish, Portuguese
M-T 7am-4pm
W-Th 10am-6pm
# DN22319 Hasan, Shadiya
NPI: 1376033654 LIC: DN22319
CERTIFICATIONS :
#014247
Guzman Orthodontics
6907 W. Waters Ave
Tampa, FL 33634
www.orthoguzman.com
(813) 887-5555
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
English
M-T 8am-5pm
W-Th 8am-5pm
# DN20141 Mann, Nicholas
NPI: 1508205139 LIC: DN20141
CERTIFICATIONS :
#020033
Toro Dental PLLC
5420 Webb Road, Ste D-1
Tampa, FL 33615
(813) 886-0545
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
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
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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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
# 19991FL Newcity, Amanda
NPI: 1457615668 LIC: 19991FL
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#015282
David P. Alfano, DDS
14037 N Dale Mabry Highway
Tampa, FL 33618
(813) 968-5743
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
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
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN15989 Jafarnia, Bahareh
NPI: 1407905730 LIC: DN15989
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#010847
Great Expressions Dental Centers
15148 N. Dale Mabry Hwy
Tampa, FL 33618
(813) 960-0106
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
Lithia, FL 33547
(813) 490-1982
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 46 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15989 Jafarnia, Bahareh
NPI: 1407905730 LIC: DN15989
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#010867
Great Expressions Dental Centers
2468 W. Brandon Blvd
Brandon, FL 33511
(813) 654-6700
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
#010984
Great Expressions Dental Centers
6552 Gunn Hwy
Tampa, FL 33625
(813) 963-0307
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
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
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
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
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
#016186
Great Expressions Dental Centers
3806 W. Linebaugh Ave
Tampa, FL 33618
(813) 960-0917
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN19207 Bui, LoanAnh
NPI: 1003883422 LIC: DN19207
CERTIFICATIONS :
• Inhalation Sedation
# DN21471 Monteleone, Chelsea
NPI: 1124497821 LIC: DN21471
CERTIFICATIONS :
• Inhalation Sedation
# DN18658 Rosen, David
NPI: 1093944274 LIC: DN18658
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#010392
Greenberg Dental & Orthodontics
2702 W. Hillsborough Ave
Tampa, FL 33614
(813) 365-3021
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
#013936
Greenberg Dental & Orthodontics
9618 Us Hwy 301 S
Riverview, FL 33578
(813) 867-7062
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN22366 Iyer, Priyanka
NPI: 1477971919 LIC: DN22366
CERTIFICATIONS :
• Inhalation Sedation
#015210
Greenberg Dental & Orthodontics
8851 N. 56Th St
Temple Terrace, FL 33617
(813) 381-5628
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
#021732
Greenberg Dental & Orthodontics
111 W. Alexander Street
Plant City, FL 33563
(813) 708-6732
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
# DN21662 Adibi, Farnaz
NPI: 1902242431 LIC: DN21662
CERTIFICATIONS :
• Inhalation Sedation
# DN21050 Lee, Sara
NPI: 1740673185 LIC: DN21050
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
• Inhalation Sedation
#017044
Growing Smiles Dental Care
18964 N. Dale Mabry Hwy, Ste 101
Lutz, FL 33548
www.growingsmilesdentalcare.com
(813) 591-1568
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
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
English, Spanish, Creoles and Pidgins
(other)
M-T 9am-4pm
W-Th 9am-4pm
# DN17860 Ceino, Cruz
NPI: 1801991732 LIC: DN17860
CERTIFICATIONS :
• Inhalation Sedation
#010448
Kids Smiles Dental, PLLC
6323 Memorial Hwy #131
Tampa, FL 33615
(813) 889-0780
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
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
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
13039 Summerfield Square Drive
Riverview, FL 33578
(813) 677-3047
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
#012063
Michael J. Ruelf, D.D.S.
1308 W. Fletcher Ave
Tampa, FL 33612
(813) 264-6000
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21749 Black, Harrison
NPI: 1750780052 LIC: DN21749
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#012948
Pediatric Dental Center
1540 S Dale Mabry Hwy
Tampa, FL 33629
(813) 254-8457
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN6377 Gonzalez, William
NPI: 1003930579 LIC: DN6377
CERTIFICATIONS :
#013982
Smile Design
5306 Van Dyke Rd
Lutz, FL 33558
(813) 960-3300
English
M 8am - 4pm, T 9am - 6pm
W-Th 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 48 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# 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
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
English
M 10am - 7pm, T 8am - 4pm
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
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
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
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
#FQHC022679
Tampa Family Health Centers, Inc
12085 W. Hillsborough Ave
Tampa, FL 33635
(813) 866-0930
English
M-T 8am-5pm
W-F 8am-5pm
# DN15880 Tibby, Tamara-Kay
NPI: 1508893850 LIC: DN15880
CERTIFICATIONS :
• Board Certification
#010449
Young Smiles Pediatric Dentistry
and Spa, PA
13131 Kings Lake Drive, Ste #104
Gibsonton, FL 33534
(813) 829-9075
English, Spanish
M-T 9am-6pm
W 9am-6pm, Th 8am-5pm,F
8am-12pm
# DN15193 Young, Kera*
NPI: 1467484097 LIC: DN15193
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
PROSTHODONTICS
#011011
Great Expressions Dental Centers
4333 W. Bay To Bay Blvd
Tampa, FL 33629
(813) 837-5147
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
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
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 :
#FQHC7649
Treasure Coast Community
Health, Inc
12196 County Road, # 512
Fellsmere, FL 32948
www.tcchinc.org
(772) 257-8224
English, Spanish
M-T 8am-5pm
W 7am-4pm, Th 8am-6pm,F 8am-3pm
S 8am - 3pm
# DN16693 Davis, Robert
NPI: 1770585275 LIC: DN16693
CERTIFICATIONS :
# DN18780 Dietz, Cristen
NPI: 1558590851 LIC: DN18780
CERTIFICATIONS :
# HAD63 Kestranek, John
NPI: 1851437354 LIC: HAD63
CERTIFICATIONS :
# DN12337 Knowles, Norman
NPI: 1588766513 LIC: DN12337
CERTIFICATIONS :
• Conscious Sedation
# DN9654 Kronick, Neil
NPI: 1538179528 LIC: DN9654
CERTIFICATIONS :
# 019029133 Marijanovic, Christine
NPI: 1538414073 LIC: 019029133
CERTIFICATIONS :
• Inhalation Sedation
# DN21185 McAndrew, Matthew
NPI: 1194104646 LIC: DN21185
CERTIFICATIONS :
#FQHC7650
Treasure Coast Community
Health, Inc
1545 9Th St Sw
Vero Beach, FL 32962
www.tcchinc.org
(772) 257-8224
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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 :
# DN18780 Dietz, Cristen
NPI: 1558590851 LIC: DN18780
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
English
M-T 9am-5pm
W-F 9am-5pm
# DN16640 Casto, Glen
NPI: 1184705832 LIC: DN16640
CERTIFICATIONS :
ORAL SURGEON
#FQHC7649
Treasure Coast Community
Health, Inc
12196 County Road, # 512
Fellsmere, FL 32948
www.tcchinc.org
(772) 257-8224
English, Spanish
M-T 8am-5pm
W 7am-4pm, Th 8am-6pm,F 8am-3pm
S 8am - 3pm
# HAD61 Carlin, Richard
NPI: 1902959414 LIC: HAD61
CERTIFICATIONS :
ORTHODONTIST
#022655
Kevin S. Vakani DDS PLLC
2050 40Th Ave, Ste 4
Vero Beach, FL 32960
(772) 400-1304
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21191 Vakani, Kevin
NPI: 1548618523 LIC: DN21191
CERTIFICATIONS :
JACKSON COUNTY
DENTIST
#020298
Larry J. Small DMD Family
Dentistry
2822 Highway 71 Ste H
Marianna, FL 32446
(850) 272-9393
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
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 :
# 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 :
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
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 :
# HAD65 Wilhite, Rhonda
NPI: 1952496341 LIC: HAD65
CERTIFICATIONS :
# DN22573 Williams, Sean
NPI: 1306376512 LIC: DN22573
CERTIFICATIONS :
ORAL SURGEON
#010535
Oral & Facial Surgery Center of
Marianna
4293 Lafayette St
Marianna, FL 32446
(850) 386-4602
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
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
140 Sw Virginia Circle
Mayo, FL 32066
(386) 294-1321
English
M 8am - 5pm,
# DN12159 Hill, Elizabeth
NPI: 1760490734 LIC: DN12159
CERTIFICATIONS :
LAKE COUNTY
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 50 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
DENTIST
#022327
Advanced Children's Dentistry
1020 W. Highway 50
Clermont, FL 34711
(352) 404-5105
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S-Su 9am-5pm
# DN24202 Abed, Ajmal
NPI: 1023429255 LIC: DN24202
CERTIFICATIONS :
#015274
Central Florida Dental Care, LLC
2390 W. Old Hwy 441, Ste 2
Mount Dora, FL 32757
(352) 735-5255
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
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
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
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 :
#CHC10282
DOH - Lake County Health
Department
875 Oakley Seaver Dr
Clermont, FL 34711
(352) 989-9001
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 :
#015128
Greenberg Dental - Clermont
680 E. State Rd 50
Clermont, FL 34711
(352) 241-4500
M 7am - 5pm, T 7am - 7pm
W 7am-7pm, Th 7am-5pm,F 8am-4pm
S 8am - 3pm
# DN23374 Calhoun, Steven
NPI: 1942792916 LIC: DN23374
CERTIFICATIONS :
# DN24633 Dobrozdravic, Amy
NPI: 1922584291 LIC: DN24633
CERTIFICATIONS :
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN22912 Jones, Nathan
NPI: 1306369830 LIC: DN22912
CERTIFICATIONS :
# DN23072 Mezquia, Freddy
NPI: 1679095970 LIC: DN23072
CERTIFICATIONS :
• Inhalation Sedation
# DN23391 Rodriguez Leyva, Luis
NPI: 1639661010 LIC: DN23391
CERTIFICATIONS :
#015135
Greenberg Dental - Leesburg
949 N. 14Th St
Leesburg, FL 34748
(352) 460-0164
English, Spanish, French
M-T 8am-6pm
W-Th 8am-6pm
S 8am - 2pm
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
#011629
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Greenberg Dental & Orthodontics
PA - Eustis
15455 Us Hwy 441
Eustis, FL 32726
(352) 399-0911
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
#016498
Jeff Molloy DDS PA
820 W Montrose Street
Clermont, FL 34711
(352) 394-4567
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
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
English, Arabic, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17585 Mousa, Ammar
NPI: 1962413781 LIC: DN17585
CERTIFICATIONS :
#FQHC7969
South Lake Dental (Community
Health Ctr)
1296 W. Broad Street
Groveland, FL 34736
(407) 905-8827
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
# DN16458 Teodoru, Catalin
NPI: 1407854847 LIC: DN16458
CERTIFICATIONS :
# DN23384 Vo, Tina*
NPI: 1548754849 LIC: DN23384
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#020863
Clermont Kids Dentistry
1655 E. Highway 50 Ste# 101
Clermont, FL 34711
www.clermontkidsdentistry.com
(407) 205-1114
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
M 7am - 5pm, T 7am - 7pm
W 7am-7pm, Th 7am-5pm,F 8am-4pm
S 8am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015135
Greenberg Dental - Leesburg
949 N. 14Th St
Leesburg, FL 34748
(352) 460-0164
English, Spanish, French
M-T 8am-6pm
W-Th 8am-6pm
S 8am - 2pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#011629
Greenberg Dental & Orthodontics
PA - Eustis
15455 Us Hwy 441
Eustis, FL 32726
(352) 399-0911
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
# DN21745 Hermano, Mark
NPI: 1902342264 LIC: DN21745
CERTIFICATIONS :
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#020458
Main Street Childrens Dentistry
& Ortho Of Clermont PLLC
2410 E. Highway 50, Bldg D, Ste A
Clermont, FL 34711
(352) 432-0090
English
M-T 8am-5pm
W-Th 8am-5pm
# DN22163 Moini, Morvarid
NPI: 1215380712 LIC: DN22163
CERTIFICATIONS :
• Inhalation Sedation
# DN20826 Tejada, Rodolfo
NPI: 1427345057 LIC: DN20826
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
LEE COUNTY
DENTIST
#011545
Edison Mall Dental PA
4125 Cleveland Ave Ste 1430
Fort Myers, FL 33901
(239) 939-9050
English, Russian, Spanish
M-T 10am-5pm
W-F 10am-5pm
S 10am - 4pm
# DN10027 Dolce, Vincent
NPI: 1760662035 LIC: DN10027
CERTIFICATIONS :
• Inhalation Sedation
#FQHC010638
Family Health Centers of
Southwest Florida, Inc.
11921 Saradrienne Lane, Ste 8
Bonita Springs, FL 34135
(239) 344-2322
English, Spanish
M-T 8am-5pm
Th-F 8am-5pm
# DN17266 Natali, Anabel
NPI: 1386606127 LIC: DN17266
CERTIFICATIONS :
• Inhalation Sedation
#FQHC010639
Family Health Centers of
Southwest Florida, 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 52 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
3600 Broadway Ave, Ste A
Fort Myers, FL 33901
(239) 344-2335
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN6062 Mazzeo Jr., Frank
NPI: 1962597047 LIC: DN6062
CERTIFICATIONS :
#FQHC010640
Family Health Centers of
Southwest Florida, Inc.
2232 Grand Ave
Fort Myers, FL 33901
www.fhcswf.org
(239) 344-2344
English, Spanish
M-T 8am-5pm
W 8am-5pm, Th 8am-6pm,F 8am-5pm
# DN6062 Mazzeo Jr., Frank
NPI: 1962597047 LIC: DN6062
CERTIFICATIONS :
#FQHC010643
Family Health Centers of
Southwest Florida, Inc.
3415 Lee Blvd
Lehigh Acres, FL 33971
(239) 344-2385
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17266 Natali, Anabel
NPI: 1386606127 LIC: DN17266
CERTIFICATIONS :
• Inhalation Sedation
#FQHC011185
Family Health Centers of
Southwest Florida, Inc.
19701 S Tamiami Trl
Fort Myers, FL 33908
(239) 314-1630
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17266 Natali, Anabel
NPI: 1386606127 LIC: DN17266
CERTIFICATIONS :
• Inhalation Sedation
#FQHC012768
Family Health Centers of
Southwest Florida, Inc.
316 Del Prado Blvd
Cape Coral, FL 33990
www.fhcswf.org
(239) 226-2630
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN6062 Mazzeo Jr., Frank
NPI: 1962597047 LIC: DN6062
CERTIFICATIONS :
#010855
Great Expressions Dental Centers
10580 Colonial Blvd, Ste 103
Ft Myers, FL 33913
(239) 210-2926
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
English
M-T 8am-5pm
W-F 7am-3pm
# 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
M-T 8am-5pm
W-F 8am-5pm
# DN23256 Cubero, Lilyann
NPI: 1942741863 LIC: DN23256
CERTIFICATIONS :
# DN10744 Fidler, Russell
NPI: 1801973466 LIC: DN10744
CERTIFICATIONS :
# DN22778 Naik, Sejal
NPI: 1619497138 LIC: DN22778
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN10744 Fidler, Russell
NPI: 1801973466 LIC: DN10744
CERTIFICATIONS :
#011230
Great Expressions Dental Centers
25195 Chamber Of Commerce Drive
Bonita Springs, FL 34135
(239) 947-7481
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
English
M-T 8am-5pm
W-F 8am-5pm
# DN22778 Naik, Sejal
NPI: 1619497138 LIC: DN22778
CERTIFICATIONS :
#021857
Happy Smiles of Fort Myers
2675 Winkler Ave, Unit 150
Fort Myers, FL 33901
happysmilesfortmyers.com
(239) 204-2780
English, Russian, Spanish
M 10am - 5pm, T 9am - 5pm
W 9am-5pm, Th 9am-4pm,F 9am-3pm
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
CERTIFICATIONS :
# DN24425 Faizzadeh, Paula
NPI: 1912550799 LIC: DN24425
CERTIFICATIONS :
# 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
#010481
Picasso Aesthetic & Cosmetic
Dental Spa
9776 Bonita Beach Road Ste 202A
Bonita Springs, FL 34135
(239) 405-3997
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(239) 274-7687
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
English, Spanish, Portuguese
M-T 8am-5pm
W-Th 8am-5pm
# DN15473 Perales, Ricardo
NPI: 1811173560 LIC: DN15473
CERTIFICATIONS :
ENDODONTICS
#014683
Towncare Dental of Bonita
Springs, PA
16565 Vanderbilt Drive
Bonita Springs, FL 34134
(239) 498-6780
English, Spanish
T 8am - 5pm
# DN17756 Galsterer, Mark
NPI: 1780733469 LIC: DN17756
CERTIFICATIONS :
• Inhalation Sedation
ORAL SURGEON
#010855
Great Expressions Dental Centers
10580 Colonial Blvd, Ste 103
Ft Myers, FL 33913
(239) 210-2926
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN12418 Torres, Luis
NPI: 1801977582 LIC: DN12418
CERTIFICATIONS :
• General Anesthesia
PEDIATRIC DENTISTRY
#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
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
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
#010880
Pediatric Dentistry of Ft. Myers
8016 Summerlin Lakes Drive
Fort Myers, FL 33907
(239) 482-2722
English, Spanish, Portuguese,
Serbo-Croatian(Cyrillic),
Serbo-Croatian(Roman)
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 :
#014430
Preventive Dentistry For Children,
PA
260 Beth Stacey Blvd # 240
Lehigh Acres, FL 33936
kidsdentistflorifa.com
(239) 491-6977
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
#021857
Happy Smiles of Fort Myers
2675 Winkler Ave, Unit 150
Fort Myers, FL 33901
happysmilesfortmyers.com
(239) 204-2780
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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN16771 Liu, Jiguo
NPI: 1629036298 LIC: DN16771
CERTIFICATIONS :
• Conscious Sedation
• Inhalation Sedation
#FQHC018638
Neighborhood Medical Center Inc.
3013 Jim Lee Road
Tallahassee, FL 32301
www.neighborhoodmedicalcenter.org
(850) 224-2469
English, Spanish
M-T 7am-6pm
W-F 7am-6pm
# DN22475 Butler, Latoya
NPI: 1003357351 LIC: DN22475
CERTIFICATIONS :
# DN19383 Garraway, Chinara
NPI: 1629364153 LIC: DN19383
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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 :
LEVY COUNTY
DENTIST
#CHC015358
DOH - Levy County Health
Department
66 W. Main St
Bronson, FL 32621
(352) 486-5300
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN15416 Elam, Christine
NPI: 1922136092 LIC: DN15416
CERTIFICATIONS :
#FQHC015483
Palms Dentistry
630 N. Main St
Williston, FL 32696
www.palmsmg.org
(352) 528-2447
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
# DN20927 Rooney, Matthew
NPI: 1598165532 LIC: DN20927
CERTIFICATIONS :
• Inhalation Sedation
LIBERTY COUNTY
DENTIST
#014656
Healthy Smiles, Happy Students -
School Based Only
17316 Ne Sr 65
Hosford, FL 32334
(850) 379-5800
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
English
M-T 8am-5pm
W-Th 8am-5pm
# DN18144 Allen, Matthew
NPI: 1871744896 LIC: DN18144
CERTIFICATIONS :
• Inhalation Sedation
MANATEE COUNTY
DENTIST
#012473
Greenberg Dental & Orthodontics
5580 Cortez Rd W
Bradenton, FL 34210
(941) 914-9181
English, Spanish
M-T 7am-3pm
W-Th 11am-7pm
S 7am - 2pm
# DN23924 Castillo, Isabel
NPI: 1477962413 LIC: DN23924
CERTIFICATIONS :
# DN23467 Folks, Garrett
NPI: 1437643137 LIC: DN23467
CERTIFICATIONS :
• Inhalation Sedation
#012755
Greenberg Dental & Orthodontics
579 10Th St E
Palmetto, FL 34221
(941) 315-9914
English, Spanish
M 7am - 3pm, T 11am - 7pm
Th-F 7am-3pm
# DN22858 Kang, Youngjn
NPI: 1538680053 LIC: DN22858
CERTIFICATIONS :
• Inhalation Sedation
# DN22862 Patel, Mitul
NPI: 1679094197 LIC: DN22862
CERTIFICATIONS :
#014072
Greenberg Dental & Orthodontics
8446 Lockwood Ridge Rd
Sarasota, FL 34243
(941) 312-2024
English, Spanish
M 10am - 6pm, T 8am - 4pm
W 8am-4pm, Th 10am-6pm,F
7am-3pm
# DN22858 Kang, Youngjn
NPI: 1538680053 LIC: DN22858
CERTIFICATIONS :
• Inhalation Sedation
# DN22658 Laurey, Violet
NPI: 1194254789 LIC: DN22658
CERTIFICATIONS :
• Inhalation Sedation
#020826
Greenberg Dental & Orthodontics
3122 53Rd Ave East
Bradenton, FL 34203
(941) 357-2968
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 :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN24318 Treyz, Carl
NPI: 1679133276 LIC: DN24318
CERTIFICATIONS :
#014960
Greenberg Dental &
Orthodontics-Bradenton
8754 E. State Road 70 Ste 8752
Bradenton, FL 34202
(941) 702-2229
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 :
# DN21327 Dockus, Matthew
NPI: 1013399013 LIC: DN21327
CERTIFICATIONS :
# DN23467 Folks, Garrett
NPI: 1437643137 LIC: DN23467
CERTIFICATIONS :
• Inhalation Sedation
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN23380 Hernandez Moreno, Rosa
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1124510508 LIC: DN23380
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
# DN22832 Letteri, Nicholas
NPI: 1992237937 LIC: DN22832
CERTIFICATIONS :
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN23461 Musselman, Robert
NPI: 1588158505 LIC: DN23461
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
# 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
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# DN24318 Treyz, Carl
NPI: 1679133276 LIC: DN24318
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#FQHC015357
Lawton Chiles Dental
1515 26Th Ave East
Bradenton, FL 34208
(941) 708-7607
English, Spanish
M 8am - 8pm, T 8am - 5pm
W-F 8am-5pm
# 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 :
# HAD99 Potts-Williams, Madge
NPI: 1902028780 LIC: HAD99
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
English, Arabic, Russian, Spanish
M-T 9am-5pm
W-F 9am-5pm
# 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
English
# DN21300 Alonso, Anamevys
NPI: 1669868147 LIC: DN21300
CERTIFICATIONS :
# DN19659 Cherry, Jerry
NPI: 1700172129 LIC: DN19659
CERTIFICATIONS :
# DN18543 Keo, Phanith
NPI: 1285828491 LIC: DN18543
CERTIFICATIONS :
# DN13120 Martinez, Susana
NPI: 1215015144 LIC: DN13120
CERTIFICATIONS :
# DN19389 Sanchez, Arnaldo
NPI: 1831486844 LIC: DN19389
CERTIFICATIONS :
#FQHC015356
Manatee Village Dental Center
1312 Manatee Ave East
Bradenton, FL 34208
(941) 708-8710
English, Spanish
M 8am - 8pm, T 8am - 5pm
Th-F 8am-5pm
# 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 :
# DN19389 Sanchez, Arnaldo
NPI: 1831486844 LIC: DN19389
CERTIFICATIONS :
#020059
Montiel Dental Care PA
6818 14Th St W
Bradenton, FL 34207
(941) 782-8058
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
English, Spanish, French
M-T 4pm-7pm
W-Th 4pm-7pm
S 9am - 1pm
# DN5019 Ward, Clifford
NPI: 1386856615 LIC: DN5019
CERTIFICATIONS :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
ORAL SURGEON
#014960
Greenberg Dental &
Orthodontics-Bradenton
8754 E. State Road 70 Ste 8752
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Bradenton, FL 34202
(941) 702-2229
English, Spanish
M-T 11am-7pm
W-Th 8am-4pm
S 7am - 2pm
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# DN19281 Guerra-Andrade, Andres
NPI: 1669610044 LIC: DN19281
CERTIFICATIONS :
• General Anesthesia
# 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
Bradenton, FL 34203
(813) 968-2483
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21728 Cetta, Christopher
NPI: 1689893240 LIC: DN21728
CERTIFICATIONS :
#014960
Greenberg Dental &
Orthodontics-Bradenton
8754 E. State Road 70 Ste 8752
Bradenton, FL 34202
(941) 702-2229
English, Spanish
M-T 11am-7pm
W-Th 8am-4pm
S 7am - 2pm
# DN22319 Hasan, Shadiya
NPI: 1376033654 LIC: DN22319
CERTIFICATIONS :
#014774
Mann Orthodontics, PA
4915 96Th St. East
Palmetto, FL 34221
www.mannmadesmiles.com
(941) 359-9711
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
Bradenton, FL 34203
(813) 968-2483
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
English
W 8am-12pm,
# DN5961 Bowles, David
NPI: 1649342635 LIC: DN5961
CERTIFICATIONS :
• General Anesthesia
#014960
Greenberg Dental &
Orthodontics-Bradenton
8754 E. State Road 70 Ste 8752
Bradenton, FL 34202
(941) 702-2229
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
(813) 889-0780
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# 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
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
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
English
# DN19841 Grant, Debbie
NPI: 1639434749 LIC: DN19841
CERTIFICATIONS :
#FQHC015356
Manatee Village Dental Center
1312 Manatee Ave East
Bradenton, FL 34208
(941) 708-8710
English, Spanish
M 8am - 8pm, T 8am - 5pm
Th-F 8am-5pm
# DN19841 Grant, Debbie
NPI: 1639434749 LIC: DN19841
CERTIFICATIONS :
MARION COUNTY
DENTIST
#020722
Dental Team of Ocala
3235 Sw 34Th Street Ste 103
Ocala, FL 34474
(352) 512-0733
English, Spanish
M-T 9am-5pm
W 9am-5pm,
# DN15287 Fernandez, Jessica
NPI: 1891825709 LIC: DN15287
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 57 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#011112
Dental Team of Ocala, West
8750 Sw Hwy 200, Ste 101
Ocala, FL 34481
(352) 840-7077
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
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
English, Spanish, Vietnamese
M-T 7am-4pm
W-F 7am-4pm
S 9am - 11am
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN23294 Brambila, Danielle
NPI: 1720577703 LIC: DN23294
CERTIFICATIONS :
• Inhalation Sedation
# DN22843 Carmona, Ashley
NPI: 1871018770 LIC: DN22843
CERTIFICATIONS :
# DN17219 Colon, Agdha
NPI: 1487614533 LIC: DN17219
CERTIFICATIONS :
# DN19357 Correal, Juliana
NPI: 1811281710 LIC: DN19357
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN14554 Daccache, Danny
NPI: 1376502104 LIC: DN14554
CERTIFICATIONS :
# DN21288 Do, TuTrinh
NPI: 1760863864 LIC: DN21288
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 :
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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 :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
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
# DN22842 Lopez, Matthew
NPI: 1932622917 LIC: DN22842
CERTIFICATIONS :
# DN20943 Marin Jimenez, Laura
NPI: 1457751075 LIC: DN20943
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 :
# 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 :
# DN20882 Patel, Janisha
NPI: 1740689371 LIC: DN20882
CERTIFICATIONS :
# DN22580 Patel, Maitri
NPI: 1447770516 LIC: DN22580
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 :
# DN21852 Priemer, Ryan
NPI: 1427407634 LIC: DN21852
CERTIFICATIONS :
• Inhalation Sedation
# DN20411 Rivera, Abneris
NPI: 1467710160 LIC: DN20411
CERTIFICATIONS :
# DN20541 Rizziello, Derrick
NPI: 1235559410 LIC: DN20541
CERTIFICATIONS :
• Inhalation Sedation
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
English, Spanish, Vietnamese
M 8am - 4pm,
W 8am-4pm,
# DN11922 Amaro, David
NPI: 1528120383 LIC: DN11922
CERTIFICATIONS :
# DN23374 Calhoun, Steven
NPI: 1942792916 LIC: DN23374
CERTIFICATIONS :
# DN22843 Carmona, Ashley
NPI: 1871018770 LIC: DN22843
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 :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN14554 Daccache, Danny
NPI: 1376502104 LIC: DN14554
CERTIFICATIONS :
# DN21288 Do, TuTrinh
NPI: 1760863864 LIC: DN21288
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 :
# DN21287 Gannon, Robert
NPI: 1285051235 LIC: DN21287
CERTIFICATIONS :
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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
# DN22842 Lopez, Matthew
NPI: 1932622917 LIC: DN22842
CERTIFICATIONS :
# 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 :
# 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
# DN23391 Rodriguez Leyva, Luis
NPI: 1639661010 LIC: DN23391
CERTIFICATIONS :
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
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
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 :
# DN15057 Greenwald, Lara
NPI: 1417126699 LIC: DN15057
CERTIFICATIONS :
#FQHC013562
Heart of Florida Health Center Inc
255 Se 17Th St
Ocala, FL 34471
(352) 274-9731
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN23944 Batista, Claudia
NPI: 1447747449 LIC: DN23944
CERTIFICATIONS :
# DN23942 Cameron, Casey
NPI: 1548758147 LIC: DN23942
CERTIFICATIONS :
# DN15057 Greenwald, Lara
NPI: 1417126699 LIC: DN15057
CERTIFICATIONS :
#FQHC10256
Langley Health Services
7205 Se Maricamp Rd
Ocala, FL 34472
(352) 680-7011
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19878 Clinton, Edna
NPI: 1376853929 LIC: DN19878
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
English, Arabic
M-T 8am-5pm
W-F 8am-5pm
# DN21167 Al Hadithi, Mohammed
NPI: 1992196828 LIC: DN21167
CERTIFICATIONS :
ENDODONTICS
#016115
Greenberg Dental & Orthodontics
4901 E. Silver Springs Blvd, Ste 600
Ocala, FL 34470
(352) 559-2764
English, Spanish, Vietnamese
M 8am - 4pm,
W 8am-4pm,
# DN18014 Baker, James
NPI: 1467650648 LIC: DN18014
CERTIFICATIONS :
• Inhalation Sedation
# DN18944 Cherian, Shiju
NPI: 1306164876 LIC: DN18944
CERTIFICATIONS :
# DN19593 Mir, Hamza
NPI: 1194094938 LIC: DN19593
CERTIFICATIONS :
# DN5060 Schwartz II, William
NPI: 1437370640 LIC: DN5060
CERTIFICATIONS :
# DN19908 Sreekantaiah, Kiran
NPI: 1437406527 LIC: DN19908
CERTIFICATIONS :
• Inhalation Sedation
#022670
North Central Florida Endodontics
48 Se 16Th Ave
Ocala, FL 34471
(352) 629-5898
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
#016115
Greenberg Dental & Orthodontics
4901 E. Silver Springs Blvd, Ste 600
Ocala, FL 34470
(352) 559-2764
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
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# 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
# 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 :
# 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 60 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
PEDIATRIC DENTISTRY
#016114
Greenberg Dental & Orthodontics
3131 Sw College Rd, Ste 202
Ocala, FL 34474
(352) 414-1560
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
# 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
English, Spanish, Vietnamese
M 8am - 4pm,
W 8am-4pm,
# DN18391 Harrell, Laurie
NPI: 1568625846 LIC: DN18391
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
• Pediatric Conscious Sedation
# 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
# 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
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
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
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
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 :
# DN18121 Palacios, Eric
NPI: 1376778084 LIC: DN18121
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
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 :
# DN18121 Palacios, Eric
NPI: 1376778084 LIC: DN18121
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN22051 Sonchaiwanich, Keith
NPI: 1790137859 LIC: DN22051
CERTIFICATIONS :
#010868
Great Expressions Dental Centers
6035 Se Federal Hwy
Stuart, FL 34997
(772) 223-4003
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN22985 McCourt, Sarah
NPI: 1083139653 LIC: DN22985
CERTIFICATIONS :
• Inhalation Sedation
# DN22051 Sonchaiwanich, Keith
NPI: 1790137859 LIC: DN22051
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 61 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# 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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN23108 Farrah, Rose
NPI: 1588169254 LIC: DN23108
CERTIFICATIONS :
#019581
Stuart Dental, Inc
424 Colorado Ave
Stuart, FL 34994
(772) 286-2124
English
M-T 8am-5pm
W 8am-5pm, Th 8am-4pm
# DN13088 Hibbert, Conrad
NPI: 1245448307 LIC: DN13088
CERTIFICATIONS :
ENDODONTICS
#010868
Great Expressions Dental Centers
6035 Se Federal Hwy
Stuart, FL 34997
(772) 223-4003
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN22442 Turner, Mark
NPI: 1003252685 LIC: DN22442
CERTIFICATIONS :
• Inhalation Sedation
PEDIATRIC DENTISTRY
# 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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN20688 Acheampong, Emmanuel
NPI: 1407122252 LIC: DN20688
CERTIFICATIONS :
• Inhalation Sedation
MIAMI-DADE COUNTY
DENTIST
#011900
A & R Dental Center of Hialeah
765 E 9 St
Hialeah, FL 33010
(305) 883-4880
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
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
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
English, Spanish
M 9am - 7pm, T 9am - 2pm
W-Th 9am-7pm
S 9am - 3pm
# 14821 Ayala, Rita
NPI: 1619090289 LIC: 14821
CERTIFICATIONS :
#013231
Adolfo E. Mares Dental Office
306 Sw 12Ave, Ste B
Miami, FL 33130
(305) 642-0535
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
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
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
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
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN14560 De la Cruz, Alejandro
NPI: 1013152016 LIC: DN14560
CERTIFICATIONS :
#013603
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Alicia B. Cayon, D.M.D., P.A.
8370 W Flagler St Ste 150
Miami, FL 33144
(305) 227-3083
English, Spanish
M 11am - 7pm, 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
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
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 10am - 3pm
# DN17506 Mora, Yosjany
NPI: 1922179613 LIC: DN17506
CERTIFICATIONS :
#013501
All Smiles General Dentistry
12404 W. Dixie Hwy
North Miami, FL 33161
(305) 893-4801
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
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
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
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN11884 Soler, Rosa
NPI: 1083738652 LIC: DN11884
CERTIFICATIONS :
#013162
America Dental Clinic
3631 Sw 87Th Ave
Miami, FL 33165
(305) 485-8427
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
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
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
#012979
Aponte Dental Corp
1350 Sw 57 Ave Ste 106
Miami, FL 33144
(305) 265-6120
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 63 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
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.com
(305) 271-0510
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
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
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 :
# DN19881 Hernandez-Jerez, Gema
NPI: 1699020347 LIC: DN19881
CERTIFICATIONS :
#009841
Best Smile Dental
1380 Ne Miami Gardens Dr Ste 132
Miami, FL 33179
(786) 517-6127
English, Spanish
M-T 8am-3pm
W-F 8am-3pm
S 8am - 1pm
# DN16229 Vidal, Maria
NPI: 1780749473 LIC: DN16229
CERTIFICATIONS :
#CHC8227
Borinquen Health Care Center,
INC
3601 Federal Hwy, 5Th Floor
Miami, FL 33137
(305) 576-6611
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
# 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
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
# DN19249 Pria, Carlos
NPI: 1811166838 LIC: DN19249
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DN16074 Soheil, Michelle
NPI: 1215014394 LIC: DN16074
CERTIFICATIONS :
#009814
Bravo Dental P.A.
909 N. Miami Beach Blvd, Ste 501
North Miami Beach, FL 33162
(305) 945-9333
English, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN19497 Yanez Bravo, Maria
NPI: 1891074183 LIC: DN19497
CERTIFICATIONS :
• Inhalation Sedation
#018293
Broward Mall Dental
1334 Sw 1St St
Miami, FL 33135
(305) 230-4426
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
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
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 :
#021891
Care Smile, LLC
833 N. Homestead Blvd
Homestead, FL 33030
(305) 245-3247
English, Spanish, Creoles and Pidgins,
English-based(other)
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
M-T 8am-5pm
W-F 8am-5pm
# DN18847 De Vera, Vanessa
NPI: 1699006072 LIC: DN18847
CERTIFICATIONS :
# DN20903 Gomez Perez, Nils
NPI: 1346649118 LIC: DN20903
CERTIFICATIONS :
#021892
Care Smile, LLC
9605 W. Flagler Street
Miami, FL 33174
(305) 559-0278
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN18847 De Vera, Vanessa
NPI: 1699006072 LIC: DN18847
CERTIFICATIONS :
# DN20903 Gomez Perez, Nils
NPI: 1346649118 LIC: DN20903
CERTIFICATIONS :
#021893
Care Smile, LLC
1840 W. 49Th Street, Ste 105
Hialeah, FL 33012
(305) 362-4382
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN18847 De Vera, Vanessa
NPI: 1699006072 LIC: DN18847
CERTIFICATIONS :
# DN20903 Gomez Perez, Nils
NPI: 1346649118 LIC: DN20903
CERTIFICATIONS :
#021894
Care Smile, LLC
1757 Sw 22Nd Street
Miami, FL 33145
(786) 442-1040
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-5pm
W-F 8am-5pm
# DN18847 De Vera, Vanessa
NPI: 1699006072 LIC: DN18847
CERTIFICATIONS :
# DN20903 Gomez Perez, Nils
NPI: 1346649118 LIC: DN20903
CERTIFICATIONS :
#018443
Caring Dental Services, LLC
127 Nw 12Th Ave
Miami, FL 33128
(305) 325-1771
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 :
#006607
Cecilia Maria Rey, DDS PA
4790 Nw 7Th Street, Ste 210/211
Miami, FL 33126
(305) 448-2014
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
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
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
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
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
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 :
# 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
English, Spanish
M 10am - 6pm,
S 10am - 2pm
# DN20751 Ramos Collazo, Yoaris
NPI: 1679982748 LIC: DN20751
CERTIFICATIONS :
#FQHC7697
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Community Health Center
10300 Sw 216Th Street
Miami, FL 33190
(305) 253-5100
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 :
# 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
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 :
# 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
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 :
# 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
English, Spanish
M-T 10am-7pm
W-Th 10am-7pm
# DN16140 Carballo, Rodolfo
NPI: 1235466269 LIC: DN16140
CERTIFICATIONS :
#012646
Creative Toothwork
9000 Sw 137Th Ave Ste 205
Miami, FL 33186
(305) 386-4663
English, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN19838 Monterrey, Judith
NPI: 1023372521 LIC: DN19838
CERTIFICATIONS :
#007940
Crown Dental Corp
10728 Sw 72Nd Street
Miami, FL 33173
(305) 596-7155
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
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
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
English, Spanish
T 9am - 5pm
W-F 9am-5pm
# DN21153 Lobaina, Karina
NPI: 1063895076 LIC: DN21153
CERTIFICATIONS :
#014323
Deluxe Dental
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 66 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
4005 Sw 152Nd Ave Unit 2
Miami, FL 33185
(786) 409-5295
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
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
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 :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
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
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 :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
#019657
Dental Excellence Partners, LLC
3825 W. 16Th Ave
Hialeah, FL 33012
(786) 501-2166
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 :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#019658
Dental Excellence Partners, LLC
6801 Sw 8Th St.
Miami, FL 33144
(786) 501-2168
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 :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
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
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 :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
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 67 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#020098
Dental Excellence Partners, LLC
266 E 49Th St
Hialeah, FL 33013
(305) 823-9982
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21645 Baez Henry, Carlianette
NPI: 1235594961 LIC: DN21645
CERTIFICATIONS :
# DN22998 Boeras Garcia, Suibel
NPI: 1063939890 LIC: DN22998
CERTIFICATIONS :
# DN15630 Cano, Lourdes
NPI: 1093867947 LIC: DN15630
CERTIFICATIONS :
# DN21572 Carballo, Mauro
NPI: 1508200635 LIC: DN21572
CERTIFICATIONS :
# DN23886 Castellanos, Nicholas
NPI: 1497228621 LIC: DN23886
CERTIFICATIONS :
# DN20061 Cruz, Yarelie
NPI: 1124433305 LIC: DN20061
CERTIFICATIONS :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
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
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 :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
CERTIFICATIONS :
# DN21495 Streett, Rosario
NPI: 1801230768 LIC: DN21495
CERTIFICATIONS :
#020101
Dental Excellence Partners, LLC
13768 Sw 8Th St
Miami, FL 33184
(786) 501-2163
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 :
# DN23529 Gonzalez, Giovanni
NPI: 1417436189 LIC: DN23529
CERTIFICATIONS :
# DN19522 Hernandez, Stephanie
NPI: 1669751871 LIC: DN19522
CERTIFICATIONS :
# DN11150 Reyes, Miguel
NPI: 1407948482 LIC: DN11150
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
English, Spanish
M 10am - 7pm, T 9am - 4pm
W-Th 10am-7pm
# DN19274 Quintana, Vilma
NPI: 1598064354 LIC: DN19274
CERTIFICATIONS :
#022853
Dental Group of South Florida
13419 Sw 56Th Street
Miami, FL 33175
(305) 556-2663
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
English, Spanish
M-T 9am-6pm
W-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
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
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
English, Spanish
M-T 9am-6pm
Th-F 9am-6pm
# DN17638 Alvarez, Maria
NPI: 1124165303 LIC: DN17638
CERTIFICATIONS :
#012990
Dental Plus Inc.
11352 Quail Roost Dr
Miami, FL 33157
(305) 969-2651
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
S 9am - 2pm
# DN19504 Cordova-Pena, Noris
NPI: 1669754578 LIC: DN19504
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
#007804
Design A Smile
6437 Bird Rd
Miami, FL 33155
(305) 667-8887
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 :
#017969
Design A Smile Kendall PA
13091 Sw 88Th St
Miami, FL 33186
(305) 408-3388
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
M-T 10am-6pm
W-F 10am-6pm
S 9am - 3pm
# DN18471 Blanco, Diana
NPI: 1659536043 LIC: DN18471
CERTIFICATIONS :
#CHC014620
DOH - Miami-Dade County
Health Department
971 Nw 2Nd St
Miami, FL 33128
(305) 575-3800
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 :
#008970
Doral Dental Partners
10620 Nw 19Th Street
Doral, FL 33172
(786) 331-7055
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN12295 Collazo, Ralph
NPI: 1720155955 LIC: DN12295
CERTIFICATIONS :
#007974
Dr. Alfredo Santeiro, DDS
2555 Collins Ave, Ste C3
Miami Beach, FL 33140
www.clubatlantisdental.com
(305) 672-9698
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN12959 Santeiro, Alfredo
NPI: 1669602629 LIC: DN12959
CERTIFICATIONS :
#016275
Dr. Jauregui Dental Care Corp
5757 Sw 8Th Street, Ste 115
Miami, FL 33144
wwwdrjauregui
(305) 269-1781
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
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 :
#016113
Dr. Kleber A. Loor, DDS, PA
1450 W. Flagler St
Miami, FL 33135
www.kloordds.com
(305) 649-7800
English, Spanish
M 12pm - 6pm, T 9am - 5pm
W 8am-1pm,
S 8am - 1pm
# DN16772 Loor, Kleber
NPI: 1124037833 LIC: DN16772
CERTIFICATIONS :
#021124
Dr. Zmiles Inc.
2999 Ne 191 St. Ste #602
Aventura, FL 33180
dr-zsmiles.com
(305) 682-1795
English, Russian, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN18673 Trujillo, Zuzel
NPI: 1285860353 LIC: DN18673
CERTIFICATIONS :
#013215
EGil Dental Corp
9950 Sw 107Th Ave, Ste 201
Miami, FL 33176
(305) 595-4397
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
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
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
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN17647 Bueno, Rosa*
NPI: 1972649218 LIC: DN17647
CERTIFICATIONS :
• Inhalation Sedation
# DN15008 De Aguirre, Elizabeth*
NPI: 1467434746 LIC: DN15008
CERTIFICATIONS :
#017955
Empire Corporation
2030 Nw 22Nd Ave
Miami, FL 33142
(305) 631-2963
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN23663 Muro, Erin
NPI: 1588155253 LIC: DN23663
CERTIFICATIONS :
#011567
Estetica Dental Gables Inc
4411 West Flagler Street
Miami, FL 33134
(305) 445-5515
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN19582 Valdes, Marilyn
NPI: 1104103910 LIC: DN19582
CERTIFICATIONS :
#FQHC7694
Everglades Health Center
19300 Sw 376Th St
Homestead, FL 33034
(305) 246-4607
English, Chinese Mandarin, Creoles
and Pidgins, English-based(other),
French, Polish, Spanish
W 8am-7pm,
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 :
# 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
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
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
English, Spanish
M-T 11am-6pm
W 11am-6pm, Th 9am-6pm,F
11am-6pm
S 9am - 3pm
# DN11020 Alfonzo, Fara
NPI: 1851447684 LIC: DN11020
CERTIFICATIONS :
# 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 :
# DN18680 Cruz, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
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 :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
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 :
#009424
Family and Cosmetic Dentistry
125 Ne 8Th St Ste 1
Homestead, FL 33030
(305) 245-6458
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN11020 Alfonzo, Fara
NPI: 1851447684 LIC: DN11020
CERTIFICATIONS :
# 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 :
# DN18680 Cruz, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
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 :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
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 70 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
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 :
#009425
Family and Cosmetic Dentistry
13706 Sw 56Th St Ste 201
Miami, FL 33175
www.familyplusdentalcenters.com
(305) 387-4954
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN11020 Alfonzo, Fara
NPI: 1851447684 LIC: DN11020
CERTIFICATIONS :
# 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 :
# DN18680 Cruz, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
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 :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
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 :
#009428
Family and Cosmetic Dentistry
2900 W. 12Th Ave Ste 27
Hialeah, FL 33012
(786) 800-0171
English, Spanish
M-T 11am-7pm
W 9am-6pm, Th 11am-7pm,F
9am-6pm
S 8am - 3pm
# DN11020 Alfonzo, Fara
NPI: 1851447684 LIC: DN11020
CERTIFICATIONS :
# 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 :
# DN18680 Cruz, Karen
NPI: 1952623993 LIC: DN18680
CERTIFICATIONS :
# DN22964 Delgado, Ivette
NPI: 1679097869 LIC: DN22964
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 :
# DN21886 Martinez, Claudia
NPI: 1194175794 LIC: DN21886
CERTIFICATIONS :
# DN18073 Martinez, Miguel
NPI: 1043408271 LIC: DN18073
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 :
#022660
Family and Cosmetic Dentistry
432 Nw 12Th Ave
Miami, FL 33128
(305) 387-4954
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 :
# 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 :
#022715
Family and Cosmetic Dentistry
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
1437 Nw 1St Terr
Homestead, FL 33030
(305) 387-4954
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 :
# DN18680 Cruz, Karen
NPI: 1952623993 LIC: DN18680
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 :
# 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
Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN17580 Franco, Elba
NPI: 1013018191 LIC: DN17580
CERTIFICATIONS :
#022417
Family Dental Care
3934 Sw 8Th Street, Ste 208
Coral Gables, FL 33134
(305) 392-1958
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21526 Alvarez, Ariam
NPI: 1962841783 LIC: DN21526
CERTIFICATIONS :
#012059
Felicita Marquez Iglesias, DDS
4890 W. 3Rd Ave
Hialeah, FL 33012
(305) 826-0906
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 1pm
# DN20430 Marquez-Iglesias, Felicita
NPI: 1740619402 LIC: DN20430
CERTIFICATIONS :
#008287
Feoli Dental
1490 Ne Miami Garden Drive
Miami Gardens, FL 33179
www.feolidental.com
(305) 949-5252
English, Spanish, Creoles and Pidgins,
French-based(other)
M-T 9am-6pm
W-Th 9am-6pm
S 9am - 2pm
# DN18037 Feoli, Carmen
NPI: 1013199819 LIC: DN18037
CERTIFICATIONS :
# DN21293 Merikas, Amanda
NPI: 1669853305 LIC: DN21293
CERTIFICATIONS :
#013440
Flores Dental Group
11890 Sw 8Th Street, Ste #300
Miami, FL 33184
(305) 485-0072
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
English, Spanish
T 9am - 6pm
W 9am-6pm,
# DN22851 Garcia, Lisset
NPI: 1487036216 LIC: DN22851
CERTIFICATIONS :
#009432
Franklin Casthely D.D.S.
160 Northeast 82Nd Street
Miami, FL 33138
(305) 756-7602
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
English
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
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
English, Spanish
M 12pm - 6pm, T 9am - 3pm
W 9am-5pm, Th 9am-3pm,F 9am-5pm
S 9am - 2pm
# DN14510 Roman, Maximo
NPI: 1578676144 LIC: DN14510
CERTIFICATIONS :
#012703
Gables Exceptional Smiles
299 Alhambra Cir Ste 208
Coral Gables, FL 33134
(305) 442-9499
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Miami, FL 33145
(305) 529-9295
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
Gables Family Dental of
Allapattah
2955 Nw 17 Ave
Miami, FL 33142
(305) 504-5553
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
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
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
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
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
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
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
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
English
M-T 8am-5pm
W-F 8am-5pm
# DN21839 Heredia Laurencio,
Abelardo
NPI: 1760809149 LIC: DN21839
CERTIFICATIONS :
#007690
Great Expressions Dental Centers
17301 Nw 27Th Ave
Miami Gardens, FL 33056
(305) 624-1371
English
M-T 8am-5pm
W-F 8am-5pm
# DN21396 Dagan, Shachar
NPI: 1447632542 LIC: DN21396
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
English
M-T 8am-5pm
W-F 8am-5pm
# DN19020 De La Rua, Lissette
NPI: 1619297892 LIC: DN19020
CERTIFICATIONS :
#010850
Great Expressions Dental Centers
20335 Old Cutler Rd, Ste 200
Miami, FL 33189
(305) 238-6777
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
7300 N Kendall Drive, Ste 110
Miami, FL 33156
(305) 670-4476
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 :
#010857
Great Expressions Dental Centers
1001 Ives Dairy Road, Ste 103
Miami, FL 33179
(305) 652-3412
English
M-T 8am-5pm
W-F 8am-5pm
# DN21006 Garcia, Luisa
NPI: 1740614163 LIC: DN21006
CERTIFICATIONS :
• Inhalation Sedation
#010859
Great Expressions Dental Centers
13876 Sw 88Th Street
Miami, FL 33186
(305) 385-4215
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
English
M-T 8am-5pm
W-F 8am-7pm
S 8am - 1pm
# DN21396 Dagan, Shachar
NPI: 1447632542 LIC: DN21396
CERTIFICATIONS :
# DN21006 Garcia, Luisa
NPI: 1740614163 LIC: DN21006
CERTIFICATIONS :
• Inhalation Sedation
# 058109 Gonvcalves Cordero,
Jhezanuel Carolina
NPI: 1477979557 LIC: 058109
CERTIFICATIONS :
# DN22938 Sanchez, Diego
NPI: 1902329816 LIC: DN22938
CERTIFICATIONS :
#017205
Great Expressions Dental Centers
18835 Biscayne Blvd, Ste 180
Miami, FL 33180
(305) 570-3978
English
M-T 8am-5pm
W-F 11am-7pm
# DN21006 Garcia, Luisa
NPI: 1740614163 LIC: DN21006
CERTIFICATIONS :
• Inhalation Sedation
#013364
Hammocks Dental Center, PA
9280 Hammock Blvd, Ste #102
Miami, FL 33196
(305) 387-5700
Spanish
M 12pm - 6pm, T 9am - 3pm
W 2pm-4pm, Th 12pm-6pm
S 10am - 1pm
# DN21526 Alvarez, Ariam
NPI: 1962841783 LIC: DN21526
CERTIFICATIONS :
# 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
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
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
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
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
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
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
English, Arabic, Chinese Mandarin,
Portuguese, Romanian, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN8062 Mulkay, Esteban
NPI: 1184784423 LIC: DN8062
CERTIFICATIONS :
# DN19606 Souza, Rodrigo
NPI: 1891958146 LIC: DN19606
CERTIFICATIONS :
#007981
Hialeah Dental Center, PA
1518 West 49Th Street
Hialeah, FL 33012
www.dentilife.com
(305) 823-2661
English, Spanish
M-T 12pm-8pm
W-Th 12pm-8pm
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
S 10am - 4pm
# 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
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
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
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN19770 Hernandez, Daynet
NPI: 1336469121 LIC: DN19770
CERTIFICATIONS :
#012974
Honest Dental Service
400 Sw 27 Ave
Miami, FL 33135
(305) 456-8046
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
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
English, Spanish
M-T 9am-6pm
Th-F 9am-6pm
# DN17928 Perez, Idalmes
NPI: 1881896306 LIC: DN17928
CERTIFICATIONS :
#008229
Ignacio J. Iturralde, DMD, PA
5711 Sw 137 Ave
Miami, FL 33183
(305) 387-3232
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
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
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
Spanish
M-T 10am-7pm
W-F 10am-7pm
# 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
English, Spanish
M 9am - 5pm,
W 9am-5pm,
# DN17732 Flores, Juan
NPI: 1548459803 LIC: DN17732
CERTIFICATIONS :
#016516
Jeps Dental Group LLC
19517 Nw 57Th Ave
Opa Locka, FL 33055
(305) 627-3402
English, Spanish
M-T 9am-6pm
W-Th 9am-6pm
# DN15474 Perez-Solar, Juan
NPI: 1770658304 LIC: DN15474
CERTIFICATIONS :
#FQHC018872
Jessie Trice Community Health
Center, Inc
217 Nw 15Th Street
Miami, FL 33136
(305) 637-6400
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN19661 Williams, Tosha
NPI: 1609009463 LIC: DN19661
CERTIFICATIONS :
• Inhalation Sedation
#FQHC015997
Jessie Trice Community Health
Center, Inc.
901 E. 10Th Ave, Bay #39
Hialeah, FL 33010
(305) 637-6400
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
# DN19661 Williams, Tosha
NPI: 1609009463 LIC: DN19661
CERTIFICATIONS :
• Inhalation Sedation
#FQHC016404
Jessie Trice Community Health
Center, Inc.
490 Opa-Locka Blvd
Opa Locka, FL 33054
(305) 637-6400
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
# DN19661 Williams, Tosha
NPI: 1609009463 LIC: DN19661
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9796
Jessie Trice Community Health
Center, Inc.
5361 N.W. 22Nd Ave
Miami, FL 33142
(305) 637-6400
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
# DN19661 Williams, Tosha
NPI: 1609009463 LIC: DN19661
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9797
Jessie Trice Community Health
Center, Inc.
5607 Nw 27Th Ave, Ste 2
Miami, FL 33142
(305) 637-6400
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
# DN19661 Williams, Tosha
NPI: 1609009463 LIC: DN19661
CERTIFICATIONS :
• Inhalation Sedation
#FQHC9799
Jessie Trice Community Health
Center, Inc.
18360 N.W. 7Th Ave
Miami, FL 33169
(305) 637-6400
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
# DN19661 Williams, Tosha
NPI: 1609009463 LIC: DN19661
CERTIFICATIONS :
• Inhalation Sedation
#007902
Jose R. Geno, DMD
2200 Sw 16Th Street, Ste 202
Miami, FL 33145
(305) 854-8707
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
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
English, Spanish
M-T 9am-6pm
W-F 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 76 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN19316 Alfonso, Jossue
NPI: 1235423997 LIC: DN19316
CERTIFICATIONS :
#013606
JR Dental Office INC.
6847 W. 4Th Ave
Hialeah, FL 33014
(786) 431-5000
English, Spanish
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
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
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
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
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
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
English, Spanish
M-T 8am-8pm
W 8am-8pm,
# DN11566 Bienes, Lissette
NPI: 1275673071 LIC: DN11566
CERTIFICATIONS :
#017577
Latin Quarter Dental PA
1660 Sw 1St St
Miami, FL 33135
(305) 642-8499
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
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
English, Spanish
M-T 10am-5pm
W-Th 10am-5pm
# DN15854 Puig, Liana
NPI: 1790016202 LIC: DN15854
CERTIFICATIONS :
• Inhalation Sedation
#007913
Liliana M. Angulo Dental Family
Practice, PA
614 E. 49Th Street
Hialeah, FL 33013
(305) 846-9126
Spanish
M 9am - 3pm, T 9am - 8pm
W 9am-3pm, Th 9am-8pm
S 9am - 3pm
# DN17639 Angulo, Liliana
NPI: 1841494648 LIC: DN17639
CERTIFICATIONS :
#008948
Lobaina Dental
8822 Sw 24Th St
Miami, FL 33165
lobainadental.com
(305) 480-9838
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
English, Spanish
M-T 9am-4pm
W-F 9am-4pm
# DN18774 Lobaina, Yoan
NPI: 1245468131 LIC: DN18774
CERTIFICATIONS :
#012095
Luis M. Santamarina, D.M.D.
330 Sw 27Th Ave Ste 602
Miami, FL 33135
(305) 644-3464
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
Spanish
M-T 10am-4pm
W-F 10am-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 77 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN14504 Castellanos-Gonzalez,
Madeleine
NPI: 1487798930 LIC: DN14504
CERTIFICATIONS :
#018466
Maira Morales DDS LLC
5232 W. Flagler St
Miami, FL 33134
(305) 442-0331
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN21552 Morales, Maira
NPI: 1023202496 LIC: DN21552
CERTIFICATIONS :
#008355
Manuel E. Costa, DDS
791 E. 48Th St
Hialeah, FL 33013
(305) 769-0252
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,
PA
4830 South West 8Th Street
Coral Gables, FL 33134
www.mariacristinafernandezdds.com
(305) 446-1067
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
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
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
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
English, Spanish
M 7am - 6pm, T 7am - 5pm
Th-F 7am-5pm
# DN15270 Amundaray, Juan
NPI: 1306218797 LIC: DN15270
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
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 7am-4pm
W-F 7am-4pm
# DN15270 Amundaray, Juan
NPI: 1306218797 LIC: DN15270
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN17100 Corrales-Iglesias, Luisa
NPI: 1861546277 LIC: DN17100
CERTIFICATIONS :
#006579
Miami International Mall Dental
1455 Nw 107Th Ave, Ste 584
Doral, FL 33172
(305) 597-8787
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S 9am - 9pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN20945 Fornos, Jorge
NPI: 1831594415 LIC: DN20945
CERTIFICATIONS :
# DN14223 Gerry, Charlotte
NPI: 1770789455 LIC: DN14223
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
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 :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
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 :
#CHC022739
Miami Lakes Cosmetic Dentistry
6600 Cow Pen Road
Hialeah, FL 33014
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(305) 823-7521
English
M-T 9am-6pm
W 12pm-7pm, Th 9am-6pm,F
9am-2pm
# DN20996 Peralta, Johnny
NPI: 1396179701 LIC: DN20996
CERTIFICATIONS :
#021944
Migdalia I Seijas DDS, PA
1169 W. 35Th Street
Hialeah, FL 33012
(305) 819-0820
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
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 :
#011904
Mirtha Amador DMD, PA
357 Almeria Ave Ste 105
Coral Gables, FL 33134
(305) 569-9001
English, Spanish
M 8am - 4pm, T 8am - 5pm
W 8am-5pm, Th 8am-4pm
# DN13027 Amador, Mirtha
NPI: 1578940912 LIC: DN13027
CERTIFICATIONS :
• Inhalation Sedation
#012860
MJ Dental Office
2360 W. 68Th St Ste 124
Hialeah, FL 33016
(305) 825-7447
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 :
#021794
Molina Dental and Associates
7921 Bird Road, Ste 45
Miami, FL 33155
(305) 262-1077
M-T 8am-6pm
W-F 8am-6pm
S 9am - 2pm
# DN21386 Molina Ariza, Yudisbel
NPI: 1760865067 LIC: DN21386
CERTIFICATIONS :
#016236
Morell Dental Care
3750 W. 16 Ave Ste 236-U
Hialeah, FL 33012
www.morelldental.com
(305) 231-0545
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
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
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 :
# 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
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
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
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 :
# 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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
1251 Nw 36 Street Ste A
Miami, FL 33142
(305) 649-9443
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
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
English, Creoles and Pidgins,
English-based(other), French
M-T 9am-5pm
W-F 9am-5pm
# DN20102 Smith, Edwin
NPI: 1104263813 LIC: DN20102
CERTIFICATIONS :
#015173
Nicklaus Children's Hospital
3601 Nw 107Th Ave Ste 300
Doral, FL 33178
(786) 624-3368
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
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
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
English, Spanish
T 9am - 6pm
W-F 9am-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
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
English, Spanish
M-T 9am-7pm
W 9am-5pm, 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
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
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
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
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
(786) 502-4467
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 :
#016745
Pediatric Dental Center of
Biscayne Inc
557 Ne 81St St
Miami, FL 33138
(305) 456-2680
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 80 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# 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
# DN20908 Mutawalli, Khalid
NPI: 1750754818 LIC: DN20908
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#010834
Pediatric Dental Center of
Homestead
925 Ne 30Th Terrace, Ste 302
Homestead, FL 33033
(305) 246-3800
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
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,
PA
610 E. 4Th Ave
Hialeah, FL 33010
(305) 885-5026
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
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 :
#010480
Peggy Alvarez-Penabad
4651 Ponce De Leon Blvd, Ste 101
Coral Gables, FL 33146
(305) 548-8690
English, Spanish
M 9am - 5pm, T 9am - 1pm
W 9am-5pm, Th 9am-1pm,F 9am-5pm
S 9am - 12pm
# DN20378 Alvarez-Penabad, Peggy
NPI: 1205260601 LIC: DN20378
CERTIFICATIONS :
#021744
Perez Dental Group Inc
7801 Coral Way, Ste 122
Miami, FL 33155
(786) 360-3694
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
English, Spanish
M 8am - 3pm, T 9am - 5pm
W-F 9am-5pm
S 8am - 2pm
# DN20428 Revoredo, Karim
NPI: 1366730384 LIC: DN20428
CERTIFICATIONS :
#009435
Phanord & Associates, PA
1245 Nw 119Th St
North Miami, FL 33167
(305) 685-7863
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 :
#018714
Pro Dental Center West Hialeah
400 West 65 Street
Hialeah, FL 33012
(305) 827-0434
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
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
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
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
English, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN17350 Ramos, Luis
NPI: 1114000304 LIC: DN17350
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 81 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#022133
RC Dental
12305 Sw 112 Street
Miami, FL 33186
(305) 596-0322
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
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
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
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
(305) 456-1927
M-T 9am-6pm
W-F 9am-6pm
S 9am - 2pm
# DN21224 Ribot, Aliana
NPI: 1811377732 LIC: DN21224
CERTIFICATIONS :
#016142
Rosario G. Molina, DMD
1909 Sw 27Th Ave
Miami, FL 33145
(305) 685-5133
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
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
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
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
English, Spanish
M 10am - 7pm, T 11am - 7pm
W-Th 10am-7pm
S 10am - 2pm
# DN22962 Ruiz Rodriguez, Julian
NPI: 1447619820 LIC: DN22962
CERTIFICATIONS :
#009996
Sabal Palm Dental Associates, P.A.
5337 Ne 2Nd Ave
Miami, FL 33137
www.phanord.com
(305) 758-0815
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 :
#011966
Salazar Dental
8346 Sw 8 St
Miami, FL 33144
(305) 269-0208
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
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
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
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
English, Spanish
M 9am - 7pm, T 9am - 5pm
Th-F 9am-5pm
S 9am - 12pm
# DN17310 Lleo, Pedro
NPI: 1942306394 LIC: DN17310
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
#013826
Smile Dentistry Associates
6741 Sw 24St Street, Ste 14
Miami, FL 33155
(305) 270-5505
Spanish, English
T 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
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
(305) 557-6711
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
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
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
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
S 10am - 2pm
# DN13451 Corpas, Alfredo
NPI: 1124115837 LIC: DN13451
CERTIFICATIONS :
#FQHC7693
South Dade Health Center
13600 Sw 312Th Street
Homestead, FL 33033
(305) 242-6069
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 :
# 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
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN14672 Tobon-Angel, Elias
NPI: 1689794885 LIC: DN14672
CERTIFICATIONS :
#019580
South Dixie Dental LLC
12531 South Dixie Hwy
Miami, FL 33156
(786) 842-3132
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN13836 Gonzalez, Maria
NPI: 1518244862 LIC: DN13836
CERTIFICATIONS :
#009753
Southland Mall Dental
20505 S. Dixie Hwy Ste 1683
Miami, FL 33189
(305) 232-3737
English, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
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 :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
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 :
#016689
Stomatcare
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
15516 Sw 88Th Street
Miami, FL 33196
(305) 330-6359
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
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
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN10511 Green, George
NPI: 1609094580 LIC: DN10511
CERTIFICATIONS :
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN22695 Toribio Fabelo, Leydy
NPI: 1033639554 LIC: DN22695
CERTIFICATIONS :
• Inhalation Sedation
# DN18770 Trujillo, Madelene
NPI: 1881835767 LIC: DN18770
CERTIFICATIONS :
#018551
Stomatcare
10457 Sw 40Th St
Miami, FL 33165
(305) 602-1638
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 :
#008254
Sunset Smiles Dental Office
8585 Sw 72Nd St, Ste # 101
Miami, FL 33143
www.sunsetsmilesdental.com
(305) 270-0171
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
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
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
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
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
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
English
M-T 9am-5pm
W-Th 9am-5pm
# DN14560 De la Cruz, Alejandro
NPI: 1013152016 LIC: DN14560
CERTIFICATIONS :
#011271
The Little Tooth Doctor Doral
10717 Nw 58 Street
Doral, FL 33178
(305) 513-4058
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
13757 Sw 152 Street
Miami, FL 33177
(305) 251-5390
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
#021453
The Tooth Place
8 Palms Plz
Homestead, FL 33030
(305) 245-7974
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
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
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
English, Spanish, Mandarin
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN12723 Hui, Tin
NPI: 1952408619 LIC: DN12723
CERTIFICATIONS :
# DN20869 Kiani, Kamran
NPI: 1699175729 LIC: DN20869
CERTIFICATIONS :
#008258
Tin Wai Hui, DMD, PA
12651 S. Dixie Hwy, #400
Miami, FL 33156
(305) 595-4548
English, Spanish, Cantonese, French,
Mandarin
M 9am - 5pm, T 10am - 6pm
Th-F 10am-6pm
S 9am - 2pm
# DN12723 Hui, Tin
NPI: 1952408619 LIC: DN12723
CERTIFICATIONS :
#018995
Total Dental Family Care
15787 Sw 72Nd St
Miami, FL 33193
www.totaldentalfamilycare.com
(305) 505-3335
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN19429 Caravia, Amanda
NPI: 1336427343 LIC: DN19429
CERTIFICATIONS :
#019644
TranscenDENTAL Studio
9275 Sw 152Nd St Ste 206
Miami, FL 33157
www.tdentalstudio.com
(305) 233-3922
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
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
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
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 :
# DN16616 Villar, Tania
NPI: 1245320068 LIC: DN16616
CERTIFICATIONS :
#011679
Verrett Dental Center
3058 Nw 79 St
Miami, FL 33147
(305) 696-9999
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
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
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 :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN11945 Chin- Thompson, Angella
NPI: 1215150909 LIC: DN11945
CERTIFICATIONS :
# DN23756 Fernandez, Malena
NPI: 1740756063 LIC: DN23756
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
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN22246 Antezana, Mauricio
NPI: 1063876399 LIC: DN22246
CERTIFICATIONS :
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN22714 Fornes-Ferrero, Patricia
NPI: 1619407566 LIC: DN22714
CERTIFICATIONS :
# DN22796 Gandhi, Poorvi
NPI: 1548631229 LIC: DN22796
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 :
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
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 :
#009582
World Dental Care
1370 East 4 Ave
Hialeah, FL 33010
(305) 888-1458
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
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
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
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN18673 Trujillo, Zuzel
NPI: 1285860353 LIC: DN18673
CERTIFICATIONS :
ENDODONTICS
#015933
Cutler Bay Dental Specialty PLLC
20529 Old Cutler Rd
Cutler Bay, FL 33189
(786) 619-1159
English, Spanish
M-T 9am-5pm
Th-F 9am-5pm
# DN11671 Porras, Edgar
NPI: 1659467785 LIC: DN11671
CERTIFICATIONS :
#010762
Dental Associates of Homestead
PA
925 Ne 30 Terrace, Ste 114
Homestead, FL 33033
(305) 247-0910
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
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 :
#006638
Gateway Dental
2375 Sw 27Th Ave
Miami, FL 33145
www.gatewaydentalinc.com
(305) 856-2300
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
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN15585 Posner, William
NPI: 1730203100 LIC: DN15585
CERTIFICATIONS :
#017005
Gateway Dental
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 86 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
1400 Ne Miami Gardens Dr. Ste 201
North Miami Beach, FL 33179
(305) 856-2300
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN15585 Posner, William
NPI: 1730203100 LIC: DN15585
CERTIFICATIONS :
#007690
Great Expressions Dental Centers
17301 Nw 27Th Ave
Miami Gardens, FL 33056
(305) 624-1371
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
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
English
M-T 8am-5pm
W-F 8am-7pm
S 8am - 1pm
# DN19592 Mattos, Katia
NPI: 1003173386 LIC: DN19592
CERTIFICATIONS :
#016407
Hialeah Dental Specialty
Associates, P.L.
900 W 49Th St Ste 400
Hialeah, FL 33012
(305) 558-1211
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
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
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
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
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
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
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
#010663
Miami Beach Center for Dental
Specialties, PA
333 Arthur Godfrey Road, Ste 818
Miami Beach, FL 33140
(305) 674-0095
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 :
#010340
NSU- College of Dental Medicine -
NMB
1750 Ne 167Th St
North Miami Beach, FL 33162
(954) 262-1660
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 :
#010664
Palmetto Center for Dental
Specialties
7150 W 20Th Ave, Ste 102
Hialeah, FL 33016
(305) 556-5600
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 87 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
W-F 8am-5pm
# DN8490 Comora, Robert
NPI: 1699855361 LIC: DN8490
CERTIFICATIONS :
# DN18596 Selman, Anas
NPI: 1134354491 LIC: DN18596
CERTIFICATIONS :
ORAL SURGEON
#008914
AC Pediatric Dentistry
4410 W. 16Th Ave, Ste 52
Hialeah, FL 33012
(305) 825-9899
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
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
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
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
NPI: 1417047218 LIC: DN15235
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
#010762
Dental Associates of Homestead
PA
925 Ne 30 Terrace, Ste 114
Homestead, FL 33033
(305) 247-0910
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
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
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
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
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
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
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: 1316100464 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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17919 Hew, Damion
NPI: 1801060967 LIC: DN17919
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN15235 Saenz, Regina
NPI: 1417047218 LIC: DN15235
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
ORTHODONTIST
#011899
D & R Dentistry
14750 Sw 26 St Ste 210
Miami, FL 33185
(305) 400-8060
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN13470 Ramos, Gisleda
NPI: 1437204765 LIC: DN13470
CERTIFICATIONS :
#021662
Hodson & Meister, PA
18333 Ne 19Th Ave
Miami, FL 33179
(305) 974-6157
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
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
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
English, Spanish, Hebrew
M-T 9am-5pm
W-Th 9am-5pm
# DN19109 Rubensteen, Evan
NPI: 1780999003 LIC: DN19109
CERTIFICATIONS :
#015173
Nicklaus Children's Hospital
3601 Nw 107Th Ave Ste 300
Doral, FL 33178
(786) 624-3368
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
M-T 8am-5pm
W-F 8am-5pm
# 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
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
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
#020544
Specialty Smiles
16375 Nw 67Th Ave
Miami Lakes, FL 33014
(305) 822-6784
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN20629 Sedeno, Eddy
NPI: 1578005179 LIC: DN20629
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#008914
AC Pediatric Dentistry
4410 W. 16Th Ave, Ste 52
Hialeah, FL 33012
(305) 825-9899
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
# 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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English
M-T 9am-5pm
W-F 9am-5pm
# DN21626 Roman, Celia
NPI: 1356570303 LIC: DN21626
CERTIFICATIONS :
# 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
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
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
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 :
# 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
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 :
# 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
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
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
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
Francisco Javier Azar DDS, MPH,
PA
16777 N Miami Ave
Miami, FL 33169
www.azardentistry.com
(305) 866-3030
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
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
English
M-T 8am-5pm
W-F 8am-5pm
# DN19224 Aguilar, Liza
NPI: 1932404027 LIC: DN19224
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# 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
English
M-T 8am-5pm
W-F 8am-5pm
# DN19224 Aguilar, Liza
NPI: 1932404027 LIC: DN19224
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DN18508 Le Bona, Daisy
NPI: 1235374471 LIC: DN18508
CERTIFICATIONS :
• Inhalation Sedation
# DN19800 Pellerano, Paola
NPI: 1194152280 LIC: DN19800
CERTIFICATIONS :
• Inhalation 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
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
English
M-T 8am-5pm
W-F 8am-7pm
# DN19224 Aguilar, Liza
NPI: 1932404027 LIC: DN19224
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# 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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# 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
English
M-T 8am-5pm
W-F 8am-5pm
# DN19224 Aguilar, Liza
NPI: 1932404027 LIC: DN19224
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
# DN18508 Le Bona, Daisy
NPI: 1235374471 LIC: DN18508
CERTIFICATIONS :
• Inhalation Sedation
# DN20174 Suta, Adi
NPI: 1457791816 LIC: DN20174
CERTIFICATIONS :
• Inhalation Sedation
#017205
Great Expressions Dental Centers
18835 Biscayne Blvd, Ste 180
Miami, FL 33180
(305) 570-3978
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
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
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
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
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
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
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
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
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
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 :
# DN14474 Ortiz-Perez, Marta
NPI: 1194883835 LIC: DN14474
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN20210 Abarca, Marvin
NPI: 1316388820 LIC: DN20210
CERTIFICATIONS :
• Inhalation Sedation
# DN23247 Echeverria, Laura
NPI: 1538528914 LIC: DN23247
CERTIFICATIONS :
# DN18852 Krajewski, Helena
NPI: 1356670988 LIC: DN18852
CERTIFICATIONS :
• Inhalation Sedation
#011301
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Main Street Children's Dentistry
& Orthodontics of Homestead
925 Ne 30 Terrace, Stes #110
Homestead, FL 33033
(305) 245-0236
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
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
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
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# 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
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
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S 9am - 9pm
# DN19077 Edwards, Jenny
NPI: 1689989071 LIC: DN19077
CERTIFICATIONS :
• Board Certification
#015173
Nicklaus Children's Hospital
3601 Nw 107Th Ave Ste 300
Doral, FL 33178
(786) 624-3368
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
# 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
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
# 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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# 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
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
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
#009753
Southland Mall Dental
20505 S. Dixie Hwy Ste 1683
Miami, FL 33189
(305) 232-3737
English, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN19077 Edwards, Jenny
NPI: 1689989071 LIC: DN19077
CERTIFICATIONS :
• Board Certification
#014447
Sunkidz Pediatric Dentistry
1045 Ne 125Th St
Miami, FL 33161
sunkidzdental.com
(305) 800-5439
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
English, Spanish
M 9am - 5pm, T 7am - 4pm
W 9am-5pm, Th 7am-4pm,F
8am-12pm
# 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
Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S-Su 10am-6pm
# DN19077 Edwards, Jenny
NPI: 1689989071 LIC: DN19077
CERTIFICATIONS :
• Board Certification
PERIODONTICS
#010762
Dental Associates of Homestead
PA
925 Ne 30 Terrace, Ste 114
Homestead, FL 33033
(305) 247-0910
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
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
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN17440 Oliver, Francisco
NPI: 1437316510 LIC: DN17440
CERTIFICATIONS :
#010664
Palmetto Center for Dental
Specialties
7150 W 20Th Ave, Ste 102
Hialeah, FL 33016
(305) 556-5600
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17440 Oliver, Francisco
NPI: 1437316510 LIC: DN17440
CERTIFICATIONS :
MONROE COUNTY
DENTIST
#FQHC7692
Marathon Health Center
2855 Overseas Highway
Marathon, FL 33050
www.chisouthfl.org
(305) 743-4000
English, Chinese Mandarin, Creoles
and Pidgins, English-based(other),
French, Polish, Spanish
T 8am - 7pm
W 8am-5pm, Th 8am-7pm,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 94 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
S 10am - 2pm
# DN20570 Rameau, Rejane
NPI: 1659541175 LIC: DN20570
CERTIFICATIONS :
#FQHC011413
RHN Dental Group - Key West
3706 N. Roosevelt Blvd, Ste E
Key West, FL 33040
(305) 517-6613
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN10562 Llodra, Clara
NPI: 1205816154 LIC: DN10562
CERTIFICATIONS :
# DN23214 Rodriguez Ramos, Oscar
NPI: 1831406982 LIC: DN23214
CERTIFICATIONS :
# DN17019 Sander, Michael
NPI: 1558878744 LIC: DN17019
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#014429
Preventive Dentistry For Children,
PA
9713 Overseas Hwy
Marathon, FL 33050
(305) 743-4670
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
English, Spanish, 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) 875-6110
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
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 :
#CHC10177
DOH - Okaloosa County Health
Department
810 E. James Lee Blvd
Crestview, FL 32539
www.healthyokaloosa.com
(850) 689-5593
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 :
ENDODONTICS
#018805
Seabreeze Endodontics
4579 E Hwy 20 Ste 220
Niceville, FL 32578
(850) 424-7368
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
English
M 8am - 5pm,
W 8am-5pm,
# DN18812 Fishbein, Benjamin
NPI: 1144543620 LIC: DN18812
CERTIFICATIONS :
# DN22495 Howle, Sarah
NPI: 1215477146 LIC: DN22495
CERTIFICATIONS :
#020416
Fishbein Orthodontics
403 Hollywood Blvd Sw, Ste A-102
Fort Walton Beach, FL 32548
(850) 477-1089
English
M 8am - 5pm,
# DN18812 Fishbein, Benjamin
NPI: 1144543620 LIC: DN18812
CERTIFICATIONS :
# DN22495 Howle, Sarah
NPI: 1215477146 LIC: DN22495
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#019213
Panhandle Pediatric Dentistry,
PLLC
4506 East Hwy 20 Ste 100
Niceville, FL 32578
(850) 308-1733
English
M-T 9am-5pm
W-Th 9am-5pm
# DN23264 Johnson, Patrick
NPI: 1770932402 LIC: DN23264
CERTIFICATIONS :
• Inhalation Sedation
# DN22760 Weil, Matt
NPI: 1710250873 LIC: DN22760
CERTIFICATIONS :
• Inhalation Sedation
OKEECHOBEE COUNTY
DENTIST
#FQHC020247
Florida Community Health
Centers, Inc.
2015 Us Highway 441
Okeechobee, FL 34972
www.fchcinc.org
(863) 763-1951
English, Spanish
M 8am - 6pm, 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 95 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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 :
# DN18121 Palacios, Eric
NPI: 1376778084 LIC: DN18121
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
(407) 896-6336
English, Arabic, Bengali, Spanish
M-T 8am-4pm
W-Th 8am-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
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
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
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 :
# DN11858 Palomeque, Theresa
NPI: 1386618544 LIC: DN11858
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
# DN18247 Wray, Roger
NPI: 1528026630 LIC: DN18247
CERTIFICATIONS :
#009979
Arbor Dentistry, LLC
1112 North Rock Springs Road
Apopka, FL 32712
(407) 814-3969
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
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
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
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
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
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
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 :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#019827
Charles Arias DDS
508 N Mills Ave Ste A
Orlando, FL 32803
(407) 856-5777
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
English, Spanish
M 8am - 6pm, T 8am - 7pm
W-Th 8am-5pm
# DN18690 Nguyen, Kathleen
NPI: 1013143544 LIC: DN18690
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
#007776
Conway Dental Care
3862 Curry Ford Road
Orlando, FL 32806
(407) 894-2048
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
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
Arabic, English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN18292 Al Shareef, Amer
NPI: 1790943405 LIC: DN18292
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
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 :
#CHC10239
DOH - Orange County Health
Department
5449 S. Semoran Blvd, Ste 19B
Orlando, FL 32822
(407) 723-5264
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
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
English, Spanish
M-T 8am-6pm
W-Th 8am-5pm
# DN15208 Mcdowell-Travis, Janet
NPI: 1992072540 LIC: DN15208
CERTIFICATIONS :
# DN15582 Nicola, Rania
NPI: 1033186986 LIC: DN15582
CERTIFICATIONS :
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
#018699
Exclusive Dentistry
7326 Lake Underhill Rd
Orlando, FL 32822
(407) 704-2094
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
(407) 482-8072
Spanish, Tagalog
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
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
English, Spanish, Creoles and Pidgins,
French-based(other), Vietnamese
M 7am - 7pm, T 7am - 6pm
Th-F 7am-3pm
S 8am - 1pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015120
Greenberg Dental - Conway
4442 Curry Ford Rd Ste A
Orlando, FL 32812
(407) 482-5855
English, Spanish
M-T 9am-5pm
Th-F 7am-3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015119
Greenberg Dental - East Colonial
4307 E. Colonial Dr
Orlando, FL 32803
(407) 514-0400
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
S 8am - 1pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015132
Greenberg Dental - FL Mall
8204 Crystal Clear Ln, Ste 600
Orlando, FL 32809
(407) 239-0126
English, Arabic, Spanish
M-T 7am-3pm
W-Th 10am-6pm
S 8am - 3pm
# DN23294 Brambila, Danielle
NPI: 1720577703 LIC: DN23294
CERTIFICATIONS :
• Inhalation Sedation
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
# DN24280 Ton, Vera
NPI: 1003476623 LIC: DN24280
CERTIFICATIONS :
#015129
Greenberg Dental - Highland
7319 W. Colonial Dr
Orlando, FL 32818
(407) 294-9200
English, Spanish, Creoles and Pidgins
(other)
M-T 7am-6pm
W-Th 7am-6pm
S 8am - 1pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015121
Greenberg Dental - Kirkman
4732 S. Kirkman Rd
Orlando, FL 32811
(407) 292-7373
English, Spanish, Creoles and Pidgins,
French-based(other)
M-T 8am-7pm
W-Th 8am-7pm
S 8am - 3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015111
Greenberg Dental - Lee Road
2200 Lee Rd
Winter Park, FL 32789
(407) 628-9877
English, Spanish
M 10am - 6pm, T 9am - 5pm
W-F 7am-3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
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 98 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#007473
Greenberg Dental - Rosemont
5824 N. Orange Blossom Trail
Orlando, FL 32810
(407) 979-4881
Spanish, Creoles and Pidgins,
English-based(other)
M-T 10am-6pm
W-Th 8am-4pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015124
Greenberg Dental - Williamsburg
5316 Central Florida Pkwy
Orlando, FL 32821
(407) 239-9557
English, Spanish, Tagalog, Vietnamese
M-T 7am-7pm
W-Th 7am-7pm
S 8am - 3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015104
Greenberg Dental - Winter Garden
13361 W. Colonial Dr.
Winter Garden, FL 34787
(407) 905-9622
Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 8am - 2pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN20164 Gollob, Harrison
NPI: 1891134441 LIC: DN20164
CERTIFICATIONS :
• Inhalation Sedation
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015116
Greenberg Dental - Winter Park
3727 N. Goldenrod Rd, Ste 108
Winter Park, FL 32792
(407) 671-0001
English, Arabic, Spanish
M-T 7am-7pm
W-Th 7am-6pm
S 8am - 2pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez,
Hector*
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel*
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#014120
Greenberg Dental & Orthodontics
5425 S. Semoran Blvd., Ste 5A
Orlando, FL 32822
(407) 545-4451
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
S 8am - 2pm
# DN22843 Carmona, Ashley
NPI: 1871018770 LIC: DN22843
CERTIFICATIONS :
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN20746 Ferreira, Stephanie
NPI: 1699175745 LIC: DN20746
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015531
Greenberg Dental & Orthodontics
13188 E. Colonial Drive, Ste B5
Orlando, FL 32826
(407) 930-4035
English, Spanish, Mandarin Chinese
M-T 7am-3pm
W-Th 10am-6pm
S 7am - 2pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
#020829
Greenberg Dental & Orthodontics
2845 S. Orange Ave, Ste 180
Orlando, FL 32806
(407) 734-1882
English, Spanish
M 10am - 6pm, T 8am - 4pm
W-F 8am-4pm
S 8am - 4pm
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22842 Lopez, Matthew
NPI: 1932622917 LIC: DN22842
CERTIFICATIONS :
# DN21852 Priemer, Ryan
NPI: 1427407634 LIC: DN21852
CERTIFICATIONS :
• Inhalation Sedation
#007989
Hans R. Koenig, DMD PA
500 N. Semoran Blvd Ste 102
Orlando, FL 32807
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(407) 277-6272
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
Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN13946 Estrada, Luis
NPI: 1245258565 LIC: DN13946
CERTIFICATIONS :
• Inhalation Sedation
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
# DN10172 Stewart, Gregg
NPI: 1619977733 LIC: DN10172
CERTIFICATIONS :
#012352
LG Dental Group PA
12927 S Orange Blossom Trl
Orlando, FL 32837
(407) 240-4900
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
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
English, Arabic, Spanish
M-T 8am-5pm
W-Th 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
English, Spanish
M 8am - 6pm, T 8am - 7pm
W-Th 8am-5pm
# DN12870 Browning, Lisa
NPI: 1457570103 LIC: DN12870
CERTIFICATIONS :
# DN19362 Gonzalez, Patricia
NPI: 1760633739 LIC: DN19362
CERTIFICATIONS :
• Inhalation Sedation
#012926
Oakridge Plaza Dental, Inc
4029 W. Oakridge Rd
Orlando, FL 32809
(407) 363-1777
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
English, Spanish, Hindi
M-T 8am-4pm
W-F 8am-4pm
# DN19368 Anjum, Sumaya
NPI: 1821385931 LIC: DN19368
CERTIFICATIONS :
# DN16586 Olmos, Rodolfo
NPI: 1679616577 LIC: DN16586
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
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-4pm
W-F 8am-4pm
# DN19583 Acosta, Edwin
NPI: 1578729711 LIC: DN19583
CERTIFICATIONS :
# DN19935 Keskar, Meghan
NPI: 1417205790 LIC: DN19935
CERTIFICATIONS :
# DN11833 Lim, Peter
NPI: 1821022526 LIC: DN11833
CERTIFICATIONS :
# DN23622 Pacheco, Magda
NPI: 1699264424 LIC: DN23622
CERTIFICATIONS :
#FQHC019163
Orange Blossom Pediatrics
701 W Livingston St Bldg 800
Orlando, FL 32805
(407) 428-5751
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish, Creoles and Pidgins,
French-based(other)
M 8am - 5pm, T 8am - 6pm
W-Th 8am-5pm
# DN16298 Chery, Pascale
NPI: 1235138439 LIC: DN16298
CERTIFICATIONS :
# DN22449 Stewart, Elizabeth
NPI: 1891155271 LIC: DN22449
CERTIFICATIONS :
#010975
Silver Star Dental Center, Inc.
5028 Silver Star Road
Orlando, FL 32808
(407) 291-1997
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
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
English
T 9am - 5pm
# DN6455 Sherman, Willie
NPI: 1619063625 LIC: DN6455
CERTIFICATIONS :
#011428
Yasmin R. Ahmed, BDS, DDS, PA
647 W South St
Orlando, FL 32805
(407) 843-7426
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
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
#021700
Volusia Endodontics Maitland PA
670 N Orlando Ave, Ste 203
Maitland, FL 32751
midfloridarootcanals.com
(407) 755-4700
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 :
# 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
English, Spanish
M-T 7am-5pm
W-Th 7am-5pm
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# DN19378 Samaniego, Juan
NPI: 1467692129 LIC: DN19378
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN16473 Walcott, Sean
NPI: 1841250743 LIC: DN16473
CERTIFICATIONS :
• General Anesthesia
#020754
Oral Facial Surgical Arts, PA
10437 Moss Park Road, Ste C
Orlando, FL 32832
(407) 207-8005
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
#021362
Baptiste Orthodontics
7260 W Colonial Drive
Orlando, FL 32818
www.baptisteorthodontics.com
(407) 294-1560
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
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
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 :
#007687
OBT Dental Spa LLC
9753 S. Orange Blossom Trail #105
Orlando, FL 32837
(407) 857-8585
English, Spanish, Hindi
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
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
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN13313 DeJesus, Maritza
NPI: 1669521209 LIC: DN13313
CERTIFICATIONS :
#019184
Smiley Face
873 Good Homes Rd
Orlando, FL 32818
www.smileyface.com
(407) 723-0060
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN22961 Burris, Benjamin
NPI: 1942302294 LIC: DN22961
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#015112
Greenberg Dental - Apopka
2216 E. Semoran Blvd
Apopka, FL 32703
(407) 889-4360
English, Spanish, Creoles and Pidgins,
French-based(other), Vietnamese
M 7am - 7pm, T 7am - 6pm
Th-F 7am-3pm
S 8am - 1pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015120
Greenberg Dental - Conway
4442 Curry Ford Rd Ste A
Orlando, FL 32812
(407) 482-5855
English, Spanish
M-T 9am-5pm
Th-F 7am-3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015119
Greenberg Dental - East Colonial
4307 E. Colonial Dr
Orlando, FL 32803
(407) 514-0400
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
S 8am - 1pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015132
Greenberg Dental - FL Mall
8204 Crystal Clear Ln, Ste 600
Orlando, FL 32809
(407) 239-0126
English, Arabic, Spanish
M-T 7am-3pm
W-Th 10am-6pm
S 8am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015129
Greenberg Dental - Highland
7319 W. Colonial Dr
Orlando, FL 32818
(407) 294-9200
English, Spanish, Creoles and Pidgins
(other)
M-T 7am-6pm
W-Th 7am-6pm
S 8am - 1pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015121
Greenberg Dental - Kirkman
4732 S. Kirkman Rd
Orlando, FL 32811
(407) 292-7373
English, Spanish, Creoles and Pidgins,
French-based(other)
M-T 8am-7pm
W-Th 8am-7pm
S 8am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015111
Greenberg Dental - Lee Road
2200 Lee Rd
Winter Park, FL 32789
(407) 628-9877
English, Spanish
M 10am - 6pm, T 9am - 5pm
W-F 7am-3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#007473
Greenberg Dental - Rosemont
5824 N. Orange Blossom Trail
Orlando, FL 32810
(407) 979-4881
Spanish, Creoles and Pidgins,
English-based(other)
M-T 10am-6pm
W-Th 8am-4pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015124
Greenberg Dental - Williamsburg
5316 Central Florida Pkwy
Orlando, FL 32821
(407) 239-9557
English, Spanish, Tagalog, Vietnamese
M-T 7am-7pm
W-Th 7am-7pm
S 8am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015104
Greenberg Dental - Winter Garden
13361 W. Colonial Dr.
Winter Garden, FL 34787
(407) 905-9622
Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 8am - 2pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015116
Greenberg Dental - Winter Park
3727 N. Goldenrod Rd, Ste 108
Winter Park, FL 32792
(407) 671-0001
English, Arabic, Spanish
M-T 7am-7pm
W-Th 7am-6pm
S 8am - 2pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
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 102 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#014120
Greenberg Dental & Orthodontics
5425 S. Semoran Blvd., Ste 5A
Orlando, FL 32822
(407) 545-4451
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
S 8am - 2pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015531
Greenberg Dental & Orthodontics
13188 E. Colonial Drive, Ste B5
Orlando, FL 32826
(407) 930-4035
English, Spanish, Mandarin Chinese
M-T 7am-3pm
W-Th 10am-6pm
S 7am - 2pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#020449
HI 5 Children's Dentistry
8255 Lee Vista Blvd F-G
Orlando, FL 32829
(407) 810-0450
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN21458 Bracho-Pacheco,
Andreina
NPI: 1073940730 LIC: DN21458
CERTIFICATIONS :
• Inhalation Sedation
# DN19471 Tabares, Miguel
NPI: 1194003210 LIC: DN19471
CERTIFICATIONS :
• Inhalation Sedation
#020356
Main Street Children's Dentistry
and Orthodontics Waterford
12150 Lake Underhill Rd
Orlando, FL 32825
(321) 319-7027
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
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 :
OSCEOLA COUNTY
DENTIST
#012839
Angel's Touch Dental Office
715 E. Vine St Ste 3
Kissimmee, FL 34744
(407) 910-4749
Spanish
M-T 9am-5pm
W-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
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
#007917
Dr. Mohamed M. Zaman, D.D.S.
PLLC
11 W. Dakin Ave
Kissimmee, FL 34741
(407) 846-3662
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
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN19368 Anjum, Sumaya
NPI: 1821385931 LIC: DN19368
CERTIFICATIONS :
# DN16586 Olmos, Rodolfo
NPI: 1679616577 LIC: DN16586
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
English, Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 8am - 2pm
# 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 :
# DN22843 Carmona, Ashley
NPI: 1871018770 LIC: DN22843
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 :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
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 103 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN21288 Do, TuTrinh
NPI: 1760863864 LIC: DN21288
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 :
# DN21287 Gannon, Robert
NPI: 1285051235 LIC: DN21287
CERTIFICATIONS :
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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
# DN22842 Lopez, Matthew
NPI: 1932622917 LIC: DN22842
CERTIFICATIONS :
# 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 :
# 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
# DN21852 Priemer, Ryan
NPI: 1427407634 LIC: DN21852
CERTIFICATIONS :
• Inhalation Sedation
# DN20411 Rivera, Abneris
NPI: 1467710160 LIC: DN20411
CERTIFICATIONS :
# DN20541 Rizziello, Derrick
NPI: 1235559410 LIC: DN20541
CERTIFICATIONS :
• Inhalation Sedation
# 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 :
# 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
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#014760
Greenberg Dental & Orthodontics
1050 Buenaventura Blvd
Kissimmee, FL 34743
(407) 392-1780
English, Spanish, Portuguese, Sign
Languages
M-T 8am-4pm
W-F 8am-4pm
S 8am - 3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015330
Greenberg Dental & Orthodontics
5043 W. Irlo Bronson Memorial Hwy
Kissimmee, FL 34746
(407) 347-4865
English, Spanish
M-T 7am-3pm
W-F 7am-3pm
S 8am - 3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015118
Greenberg Dental & Orthodontics
- St. Cloud
4039 13Th St
Saint Cloud, FL 34769
(407) 892-1643
English, Spanish
M-T 7am-7pm
W-Th 7am-6pm
S 8am - 2pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN23563 Robinson Maita, Santos
NPI: 1063999613 LIC: DN23563
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#013246
Hallmark Dental
1014 Buenaventura Blvd
Kissimmee, FL 34743
(407) 344-2400
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN16586 Olmos, Rodolfo
NPI: 1679616577 LIC: DN16586
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
English, Spanish
M-T 8am-5pm
W-F 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 :
# DN22506 Pierre-Louis, Frantz
NPI: 1194091538 LIC: DN22506
CERTIFICATIONS :
# DN8243 Polite, Leroy
NPI: 1740383017 LIC: DN8243
CERTIFICATIONS :
#012264
Mid Florida Dental Associates
809 E Oak St Ste 101
Kissimmee, FL 34744
(407) 870-5004
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN14586 Henninger, Rosalba
NPI: 1598842668 LIC: DN14586
CERTIFICATIONS :
# DN20490 Powell, Makom
NPI: 1154745552 LIC: DN20490
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 105 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#FQHC016507
Osceola Community Health
Centers @ Intercession City
1703 Business Center Lane
Kissimmee, FL 34758
(407) 943-8600
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15786 Ferro, David
NPI: 1063451326 LIC: DN15786
CERTIFICATIONS :
# DN14586 Henninger, Rosalba
NPI: 1598842668 LIC: DN14586
CERTIFICATIONS :
#FQHC016505
Osceola Community Health
Centers @ Kissimmee
1875 Fortune Rd.
Kissimmee, FL 34744
(407) 943-8600
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15786 Ferro, David
NPI: 1063451326 LIC: DN15786
CERTIFICATIONS :
#FQHC016508
Osceola Community Health
Centers @Poinciana
109 N. Doverplum Ave.
Kissimmee, FL 34758
(407) 943-8600
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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 &
J
Saint Cloud, FL 34772
(407) 556-3969
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
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
English, Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 8am - 2pm
# DN18014 Baker, James
NPI: 1467650648 LIC: DN18014
CERTIFICATIONS :
• Inhalation Sedation
# DN19321 Bienias, Russell
NPI: 1144516287 LIC: DN19321
CERTIFICATIONS :
# DN18944 Cherian, Shiju
NPI: 1306164876 LIC: DN18944
CERTIFICATIONS :
# DN19593 Mir, Hamza
NPI: 1194094938 LIC: DN19593
CERTIFICATIONS :
# DN5060 Schwartz II, William
NPI: 1437370640 LIC: DN5060
CERTIFICATIONS :
# DN19908 Sreekantaiah, Kiran
NPI: 1437406527 LIC: DN19908
CERTIFICATIONS :
• Inhalation Sedation
ORAL SURGEON
# DN19573 Adams, Bryan
NPI: 1861557837 LIC: DN19573
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN9409 Burchfield, Tommie
NPI: 1639138274 LIC: DN9409
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# 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
English, Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN17160 Ason, Raphael
NPI: 1659555001 LIC: DN17160
CERTIFICATIONS :
• General Anesthesia
ORTHODONTIST
#022382
Florida Orthodontic Associates
PLLC
595 Oak Commons Blvd, Ste C
Kissimmee, FL 34741
(407) 870-0717
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
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 :
# DN17547 Hamdallah, Khaled
NPI: 1063629228 LIC: DN17547
CERTIFICATIONS :
# DN19901 Lakshmana, Shruthi
NPI: 1659763092 LIC: DN19901
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
# DN18391 Harrell, Laurie
NPI: 1568625846 LIC: DN18391
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
• Pediatric Conscious Sedation
# 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
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#014760
Greenberg Dental & Orthodontics
1050 Buenaventura Blvd
Kissimmee, FL 34743
(407) 392-1780
English, Spanish, Portuguese, Sign
Languages
M-T 8am-4pm
W-F 8am-4pm
S 8am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015330
Greenberg Dental & Orthodontics
5043 W. Irlo Bronson Memorial Hwy
Kissimmee, FL 34746
(407) 347-4865
English, Spanish
M-T 7am-3pm
W-F 7am-3pm
S 8am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015118
Greenberg Dental & Orthodontics
- St. Cloud
4039 13Th St
Saint Cloud, FL 34769
(407) 892-1643
English, Spanish
M-T 7am-7pm
W-Th 7am-6pm
S 8am - 2pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#011580
Hi-5 Children's Dentistry LLC
1202 Cypress Glen Circle
Kissimmee, FL 34741
hi-5childrensdentistry.com
(407) 810-0450
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# 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
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 :
PROSTHODONTICS
# 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
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
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
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
English, Spanish
M 10am - 5pm,
W 10am-5pm,
S 10am - 1pm
# DN20246 Lago-Sanchez, Idelbis
NPI: 1003248824 LIC: DN20246
CERTIFICATIONS :
#014070
BGR Dental
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 107 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
1825 Forest Hill Blvd Ste #205
West Palm Beach, FL 33406
(561) 733-9099
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 :
# DN22794 Lee, Chung
NPI: 1306299516 LIC: DN22794
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
English, Russian, Spanish
M-T 10am-6pm
W-F 10am-6pm
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
# DN19470 Maniglia, Marielba
NPI: 1063793644 LIC: DN19470
CERTIFICATIONS :
#022544
Cagigas Dental Services LLC
2311 10Th Ave N, Ste 14
Lake Worth, FL 33461
(561) 814-2888
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
English, Spanish, Creoles and Pidgins
(other)
M 9am - 5pm, T 9am - 6pm
W-F 9am-5pm
# DN22675 Villarreal, Ruben
NPI: 1255860706 LIC: DN22675
CERTIFICATIONS :
• Inhalation Sedation
#019689
Children's Dental Pl. of E. Boca
509 N.E. 20Th St
Boca Raton, FL 33431
(561) 620-1031
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
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
38754 State Rd 80
Belle Glade, FL 33430
(561) 370-1300
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
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
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 :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN22922 Oliveira, Paulo
NPI: 1285157826 LIC: DN22922
CERTIFICATIONS :
# DN8969 Rotella, Robert
NPI: 1447320544 LIC: DN8969
CERTIFICATIONS :
# DN17452 Seminario, Ada
NPI: 1104921592 LIC: DN17452
CERTIFICATIONS :
#FQHC016395
CL Brumback Primary Care
Clinics
225 S. Congress Ave
Delray Beach, FL 33445
hcdpbc.org
(561) 370-1303
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
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 :
# DN20710 Gonzalez, Kely
NPI: 1952717027 LIC: DN20710
CERTIFICATIONS :
# DN20151 Gonzalez, Kenia
NPI: 1578902813 LIC: DN20151
CERTIFICATIONS :
# DN12167 Kuntsmann, Vivian
NPI: 1104995539 LIC: DN12167
CERTIFICATIONS :
# DN23021 Riboul, Sandrine
NPI: 1609227057 LIC: DN23021
CERTIFICATIONS :
• Inhalation Sedation
# DN23007 Rivera, Lina
NPI: 1760908743 LIC: DN23007
CERTIFICATIONS :
#019500
Dale Pediatric Dentistry
1928 Commerce Lane Ste #1
Jupiter, FL 33458
(561) 210-7333
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
(561) 642-1177
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
# DN18835 Ortega Perez, Claudia
NPI: 1043543606 LIC: DN18835
CERTIFICATIONS :
#013217
Dr. Michael D. Quasha
4520 Donald Ross Road, Ste 105
Palm Beach Gardens, FL 33418
(561) 799-5558
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
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
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
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
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
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
English, Arabic, Creoles and Pidgins,
French-based(other), French, Spanish
M 8am - 5pm, T 8am - 7pm
W-F 8am-5pm
# DN12194 Rampertaap, Maheswar
NPI: 1235290602 LIC: DN12194
CERTIFICATIONS :
#FQHC014974
Genesis Community Health Inc
181 Crawford Blvd
Boca Raton, FL 33432
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(561) 235-5477
English, Spanish, Creoles and Pidgins
(other)
T 8am - 5pm
W-Th 8am-5pm
# DN20219 Elkind, Jaime
NPI: 1437567146 LIC: DN20219
CERTIFICATIONS :
# DN13425 Ferlita, David
NPI: 1154333235 LIC: DN13425
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
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN20219 Elkind, Jaime
NPI: 1437567146 LIC: DN20219
CERTIFICATIONS :
# DN13425 Ferlita, David
NPI: 1154333235 LIC: DN13425
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
English, Spanish
M-T 8am-5pm
W-F 7am-3pm
# DN22642 Kadiyala, Sravanthi
NPI: 1952830879 LIC: DN22642
CERTIFICATIONS :
#016227
Great Expressions Dental Centers
930 N. Congress Ave Ste 200
Boynton Beach, FL 33426
(561) 732-6900
English, Russian, Creoles and Pidgins
(other), French, Portuguese, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 9am - 2pm
# DN21396 Dagan, Shachar
NPI: 1447632542 LIC: DN21396
CERTIFICATIONS :
# DN21006 Garcia, Luisa
NPI: 1740614163 LIC: DN21006
CERTIFICATIONS :
• Inhalation Sedation
# DN17620 Harris, Ana
NPI: 1265605323 LIC: DN17620
CERTIFICATIONS :
# DN20013 Rodriguez, Narda
NPI: 1548570831 LIC: DN20013
CERTIFICATIONS :
# DN23092 Shimansky, Daniel
NPI: 1134634967 LIC: DN23092
CERTIFICATIONS :
#018488
Greenberg Dental & Orthodontics
7725 Lake Worth Rd
Lake Worth, FL 33467
(561) 508-9450
English, Spanish
M 11am - 7pm, T 7am - 3pm
Th-F 7am-3pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN19067 Antony, Kathryn
NPI: 1811209059 LIC: DN19067
CERTIFICATIONS :
• Inhalation Sedation
# DN21311 Barbela, Antal
NPI: 1508247313 LIC: DN21311
CERTIFICATIONS :
# DN18368 Bennett, James
NPI: 1659587715 LIC: DN18368
CERTIFICATIONS :
# DN20398 Burgess Chaves,
Stephanie
NPI: 1144655143 LIC: DN20398
CERTIFICATIONS :
# DN19373 Carter, Ben
NPI: 1851679666 LIC: DN19373
CERTIFICATIONS :
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN22048 Dubey, Akhil
NPI: 1982057444 LIC: DN22048
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN21460 Garcia, Emily
NPI: 1932584745 LIC: DN21460
CERTIFICATIONS :
• Inhalation Sedation
# DN20625 Garcia, Jessica
NPI: 1710394945 LIC: DN20625
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 :
# DN22134 Kinser, Jullia
NPI: 1740633262 LIC: DN22134
CERTIFICATIONS :
# DN22205 Lidhran, Paraminderpal
NPI: 1609322270 LIC: DN22205
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN22692 Nguyen, Josie*
NPI: 1548790801 LIC: DN22692
CERTIFICATIONS :
• Inhalation Sedation
• Oral / Enteral Sedation
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
# DN20824 Scarlett, Francesca
NPI: 1124437884 LIC: DN20824
CERTIFICATIONS :
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN22077 Soni, Juhi
NPI: 1821441379 LIC: DN22077
CERTIFICATIONS :
#020825
Greenberg Dental & Orthodontics
1230 Northlake Blvd
Lake Park, FL 33403
(561) 536-4463
English, Spanish
M 11am - 7pm, T 8am - 4pm
W 8am-4pm, Th 11am-7pm,F
8am-4pm
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22428 Salehi, Shiva
NPI: 1346696549 LIC: DN22428
CERTIFICATIONS :
#020827
Greenberg Dental & Orthodontics
4085 N. Haverhill Road, Ste C1
West Palm Beach, FL 33417
(561) 513-8031
English, Spanish
M 11am - 7pm, T 8am - 4pm
W 8am-4pm, Th 11am-7pm,F
8am-4pm
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
# DN22428 Salehi, Shiva
NPI: 1346696549 LIC: DN22428
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 110 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#021605
Greenberg Dental & Orthodontics
701 N. Congress Ave, Ste 9
Boynton Beach, FL 33426
(561) 740-2013
English, Spanish
M-T 8am-4pm
W 11am-7pm, Th 10am-6pm,F
8am-4pm
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN18753 Daneshpajouh, Sara
NPI: 1982836003 LIC: DN18753
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
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 :
#022013
Greenberg Dental & Orthodontics
956 Military Trl
West Palm Beach, FL 33415
(561) 284-8680
English, Spanish
M-T 8am-4pm
W 11am-7pm, Th 10am-6pm,F
8am-4pm
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
#018559
Greenberg Dental & Orthodontics
PA
14560 S. Military Trail, Ste B2
Delray Beach, FL 33484
(561) 323-7264
English, Spanish
M 11am - 7pm,
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 :
# DN22932 Rincon, Karolina
NPI: 1790293595 LIC: DN22932
CERTIFICATIONS :
# DN17455 Stein, Stacy
NPI: 1467637561 LIC: DN17455
CERTIFICATIONS :
#020193
Heavenly Smiles
135 South Us Highway 27
South Bay, FL 33493
(561) 996-0033
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
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
English, Spanish
M-T 9am-6pm
W-F 9am-6pm
S 9am - 3pm
# DN21468 Friman, Jose
NPI: 1053796938 LIC: DN21468
CERTIFICATIONS :
#009687
Juana M. Geldres, D.D.S., P.A.
1911 Forest Hill Blvd
West Palm Beach, FL 33406
(561) 439-7400
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
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
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
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
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
English, Spanish, Portuguese
M-T 8am-5pm
W 8am-5pm,
# 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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
English, Spanish, Portuguese
M-T 8am-5pm
W-Th 8am-5pm
S 8am - 1pm
# DN20957 Correa, Ali
NPI: 1972815835 LIC: DN20957
CERTIFICATIONS :
#007645
Polo Dental
1905 Clint Moore Rd, Ste 200
Boca Raton, FL 33496
(561) 241-7656
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 :
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
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
English, Russian, Creoles and Pidgins,
English-based(other), Spanish
M 9am - 5pm, T 10am - 6pm
W-F 10am-6pm
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
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
English, Chinese Mandarin, Russian,
Spanish
M-T 9am-6pm
W-F 9am-6pm
# 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
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
English, Spanish, Creoles and Pidgins,
English-based(other), Italian
M 1pm - 5pm,
W-Th 9am-5pm
# 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
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
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
S 9am - 2pm
# DN17323 Deyab, Tim
NPI: 1124119474 LIC: DN17323
CERTIFICATIONS :
#020975
Riverwalk Dental Group
759 Parkway Street, Ste 102
Jupiter, FL 33477
(561) 744-3646
English, Albanian, Creoles and
Pidgins (other), Hindi
T 12pm - 7pm
# DN18713 Chokshi, Payal
NPI: 1770714578 LIC: DN18713
CERTIFICATIONS :
#016245
Royal Dental
1301 N. Congress, Ste 110
Boynton Beach, FL 33426
(561) 292-0155
English, Russian, Spanish
M-T 9am-5pm
W 9am-5pm, Th 10am-6pm,F
9am-5pm
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
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
#009767
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
S. Congress Cosmetic & General
Dentistry
2976 S. Military Trail
West Palm Beach, FL 33415
(561) 434-6661
Spanish, English
M-T 9am-5pm
W-F 9am-5pm
# DN17929 Ramos, Idalmis
NPI: 1447452958 LIC: DN17929
CERTIFICATIONS :
#009627
Sage Dental Group of Lake Worth
P.A.
1922 Lake Worth Rd
Lake Worth, FL 33461
(561) 547-5597
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN19079 Fernandez-Martinez,
Mariangel
NPI: 1376857441 LIC: DN19079
CERTIFICATIONS :
# DN20478 Green, Beverly
NPI: 1558704122 LIC: DN20478
CERTIFICATIONS :
• Inhalation Sedation
# DN21989 Leminh, Chau
NPI: 1063863322 LIC: DN21989
CERTIFICATIONS :
# DN18330 Naguib, Michelle
NPI: 1215170980 LIC: DN18330
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
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 :
# DN20478 Green, Beverly
NPI: 1558704122 LIC: DN20478
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 :
#007513
Shapiro Family Dentistry
2247 Palm Beach Lakes Ste 104
West Palm Beach, FL 33409
www.shapirosmile.com
(561) 684-2282
English, Spanish, Creoles and Pidgins,
French-based(other), Haitian; Haitian
Creole
M-T 8am-6pm
W-Th 8am-6pm
# 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
English, Spanish, Creoles and Pidgins,
French-based(other)
M-T 9am-5pm
W-Th 9am-5pm
# 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
(561) 877-3313
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-6pm
W-F 8am-6pm
S 8am - 3pm
# 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
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
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
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
Spanish, Hebrew
M 9am - 5pm,
W 10am-4pm, Th 9am-5pm
S 9am - 2pm
# DN16456 Tavory, Yaron
NPI: 1649362088 LIC: DN16456
CERTIFICATIONS :
ENDODONTICS
#010757
Jupiter Dental Group
175 Toney Penna Drive, Ste 105
Jupiter, FL 33458
(561) 745-3118
English, Spanish
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 113 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN10933 Kosakoski, Edward
NPI: 1457482168 LIC: DN10933
CERTIFICATIONS :
# DN11671 Porras, Edgar
NPI: 1659467785 LIC: DN11671
CERTIFICATIONS :
#010647
Towncare Dental of Forest Hill
3027 Forest Hill Blvd, Ste A3
West Palm Beach, FL 33406
(561) 433-4330
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN15780 Ahn, Sunghee
NPI: 1790816882 LIC: DN15780
CERTIFICATIONS :
• Board Certification
# DN22214 Sarmiento, Jeffrey
NPI: 1184177560 LIC: DN22214
CERTIFICATIONS :
ORAL SURGEON
#010757
Jupiter Dental Group
175 Toney Penna Drive, Ste 105
Jupiter, FL 33458
(561) 745-3118
English, Spanish
W-F 9am-5pm
# DN16630 Patel, Nishul
NPI: 1952558439 LIC: DN16630
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
#019857
Surgical Arts of Boca Raton
9980 N. Central Park Blvd #113
Boca Raton, FL 33428
(561) 717-3660
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN16048 Portnof, Jason
NPI: 1760613426 LIC: DN16048
CERTIFICATIONS :
• Board Certification
• General Anesthesia
• Inhalation Sedation
#010647
Towncare Dental of Forest Hill
3027 Forest Hill Blvd, Ste A3
West Palm Beach, FL 33406
(561) 433-4330
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
(561) 790-0319
Spanish
M 8am - 6pm, T 8am - 5pm
# DN18379 Cooper, Andrew
NPI: 1710206149 LIC: DN18379
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 :
#019200
Cooper Orthodontics
509 Ne 20Th Street
Boca Raton, FL 33431
(561) 620-1067
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 :
#019201
Cooper Orthodontics
9181 Glades Road #120
Boca Raton, FL 33434
(561) 558-9467
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
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 :
#016593
Goldenberg Orthodontics PA
9250 Glades Rd, Ste 208
Boca Raton, FL 33434
(561) 756-9227
English
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
English, Spanish
M 10am - 7pm, T 9am - 5pm
W 10am-7pm, Th 9am-5pm,F
10am-5pm
# DN17192 Shelling, Robert
NPI: 1225210545 LIC: DN17192
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#022294
Boynton Beach Mall Dental PA
801 N. Congress Ave, Ste 185D
Boynton Beach, FL 33426
(561) 369-7199
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
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
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
38754 State Rd 80
Belle Glade, FL 33430
(561) 370-1300
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
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
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) 370-1303
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
Russian, Spanish
M-T 10am-5pm
W 8am-5pm, Th 10am-5pm,F
10am-2pm
S 9am - 2pm
# 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
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
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
# DN22180 Puig, Christina
NPI: 1679954788 LIC: DN22180
CERTIFICATIONS :
• Inhalation 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
English, Spanish
M-T 8am-5pm
W-F 7am-3pm
# DN20688 Acheampong, Emmanuel
NPI: 1407122252 LIC: DN20688
CERTIFICATIONS :
• Inhalation Sedation
# DN16232 Starkman, Sharlene Yap
NPI: 1265656797 LIC: DN16232
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 115 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#016227
Great Expressions Dental Centers
930 N. Congress Ave Ste 200
Boynton Beach, FL 33426
(561) 732-6900
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
#022818
Little By Little Pediatric Dentistry
Corp
1405 N. Alternate Aia, Ste 106
Jupiter, FL 33469
(561) 770-3000
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
Spanish, Arabic, English
M 8am - 6pm,
W-F 8am-2pm
# DN15894 Cortes, Bayardo
NPI: 1174604896 LIC: DN15894
CERTIFICATIONS :
• Inhalation Sedation
#017770
Little Smiles Dental #4
1708 N. Federal Hwy
Lake Worth, FL 33460
www.littlesmiledental.com
(561) 588-2025
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
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
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
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
English, Spanish, Portuguese
M-T 8am-5pm
W 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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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
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
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
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#021758
Shapiro Family Dentistry
9868 S State Road 7, Ste 200
Boynton Beach, FL 33472
(561) 877-3313
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-6pm
W-F 8am-6pm
S 8am - 3pm
# DN17836 Smith, Christina
NPI: 1104963149 LIC: DN17836
CERTIFICATIONS :
• Inhalation Sedation
#014989
Super Smiles Pediatric Dentistry
& Orthodontics
4800 Linton Blvd, Ste D505
Delray Beach, FL 33445
supersmilesfl.com
(561) 403-5429
English, Spanish
M-T 8am-5pm
# DN20401 Buscemi, Amanda
NPI: 1669808572 LIC: DN20401
CERTIFICATIONS :
• Inhalation Sedation
PERIODONTICS
#010757
Jupiter Dental Group
175 Toney Penna Drive, Ste 105
Jupiter, FL 33458
(561) 745-3118
English, Spanish
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
English, Russian, Creoles and Pidgins,
French-based(other), Spanish
M 11am - 7pm, T 9am - 5pm
Th-F 9am-5pm
# DN23115 Mendoza, Juan
NPI: 1821326430 LIC: DN23115
CERTIFICATIONS :
• Inhalation Sedation
# DN11699 Simon, David
NPI: 1508303587 LIC: DN11699
CERTIFICATIONS :
• Oral / Enteral Sedation
#014988
Polo Dental
4700 N. Congress Ave, Ste 302
West Palm Beach, FL 33407
(561) 666-9691
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
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
(561) 877-3313
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 8am-6pm
W-F 8am-6pm
S 8am - 3pm
# 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
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
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
5120 Us Highway 19 N
New Port Richey, FL 34652
(727) 847-3113
English, Spanish, Vietnamese
M-T 8am-5pm
W-F 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
# 22DI02680600 Hernandez,
Christine
NPI: 1891216784 LIC: 22DI02680600
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
6606 Forest Ave
New Port Richey, FL 34653
www.cobbedental.com
(727) 849-2454
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
# 22DI02680600 Hernandez,
Christine
NPI: 1891216784 LIC: 22DI02680600
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
#CHC10110
DOH - Pasco County Health
Department
10841 Little Rd
New Port Richey, FL 34654
(727) 619-0284
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN14205 Melean, Alfonso
NPI: 1609845031 LIC: DN14205
CERTIFICATIONS :
# DN16403 Nagabandi, Padma
NPI: 1780743161 LIC: DN16403
CERTIFICATIONS :
#CHC10111
DOH - Pasco County Health
Department
37615 Martin Luther King Blvd
Dade City, FL 33523
(352) 521-1450
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 :
#010862
Great Expressions Dental Centers
1748 Bruce B. Downs Blvd, Ste 125
Wesley Chapel, FL 33543
(813) 907-1151
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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
#010871
Great Expressions Dental Centers
7950 Gall Blvd
Zephyrhills, FL 33541
(813) 715-1271
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN21523 Cardenas, Astrid
NPI: 1962831644 LIC: DN21523
CERTIFICATIONS :
• Inhalation Sedation
# DN19638 Immadi, Lakshmi
NPI: 1083988901 LIC: DN19638
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
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
English, Spanish
M-T 8am-4pm
W-Th 11am-7pm
# DN22365 Karapasha, Christopher
NPI: 1538601455 LIC: DN22365
CERTIFICATIONS :
• Inhalation Sedation
# DN22815 LeBlanc, Malory
NPI: 1245753912 LIC: DN22815
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#FQHC014534
Premier Community HealthCare
Group Inc.
2114 Seven Springs Blvd
New Port Richey, FL 34655
(352) 518-2000
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# 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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(352) 518-2000
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
English, Spanish
T 9am - 3pm
W-Th 9am-3pm
# DN18930 Mejias, Karen
NPI: 1346572625 LIC: DN18930
CERTIFICATIONS :
• Inhalation Sedation
ORAL SURGEON
#012639
Tampa Bay Institute of Oral
Surgery & Dental Implants
19445 Shumard Oak Dr Ste 101
Land O Lakes, FL 34638
(813) 909-2354
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# 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
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
(813) 968-2483
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
PEDIATRIC DENTISTRY
#017633
Blue Wave Ortho Partners, PLLC
2234 Native Woods Lane #102
Wesley Chapel, FL 33544
www.bluewaveortho.com
(813) 968-2483
English, Spanish
T 8am - 5pm
# DN23158 Navarro, Jose
NPI: 1366883548 LIC: DN23158
CERTIFICATIONS :
• Inhalation Sedation
#010278
Dr. Bee Pediatric Dentistry
2242 Ashley Oaks Circle
Wesley Chapel, FL 33544
www.drbeepd.com
(813) 991-5300
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
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) 205-4343
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
#010871
Great Expressions Dental Centers
7950 Gall Blvd
Zephyrhills, FL 33541
(813) 715-1271
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN18658 Rosen, David
NPI: 1093944274 LIC: DN18658
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#011110
No Sugar Bugs Club Children's
Dentistry
8804 Hawbuck St
Trinity, FL 34655
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
www.nosugarbugs.com
(727) 478-3210
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 :
#FQHC014534
Premier Community HealthCare
Group Inc.
2114 Seven Springs Blvd
New Port Richey, FL 34655
(352) 518-2000
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# DN18802 Flicker, Robin
NPI: 1952531691 LIC: DN18802
CERTIFICATIONS :
• Inhalation Sedation
#FQHC011082
Premier Community HealthCare
Group, Inc.
37944 Pasco Ave
Dade City, FL 33525
PREMIERHC.ORG
(352) 518-2000
English, Spanish
M 7am - 7pm, T 7am - 4pm
W-F 7am-4pm
# DN18802 Flicker, Robin
NPI: 1952531691 LIC: DN18802
CERTIFICATIONS :
• Inhalation Sedation
#011311
Sea of Smiles, Inc.
3737 Maryweather Lane #101
Wesley Chapel, FL 33544
(813) 528-8717
English
M-T 8am-4pm
W-Th 8am-4pm
# DN17430 LaPresti, Lisa
NPI: 1386787430 LIC: DN17430
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
PINELLAS COUNTY
DENTIST
#011420
A-1 Dental
29605 Us 19 North, Ste 350
Clearwater, FL 33761
(727) 786-6649
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
English, Spanish, Portuguese
M-T 8am-5pm
W-F 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
# 22DI02680600 Hernandez,
Christine
NPI: 1891216784 LIC: 22DI02680600
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
#FQHC011250
Community Health Centers of
Pinellas, Inc
1344 22Nd Street S
St Petersburg, FL 33712
(727) 824-8181
English, Spanish
M-T 7am-6pm
W-Th 7am-6pm
# DN22253 Carter, Jade
NPI: 1487968467 LIC: DN22253
CERTIFICATIONS :
# DN19885 Dougherty, Erin
NPI: 1043565807 LIC: DN19885
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
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 :
# DN9873 Lansmann, Richard
NPI: 1427355585 LIC: DN9873
CERTIFICATIONS :
#022289
Countryside Mall Dental PA
27001 Us Highway 19 N, Ste 1031B
Clearwater, FL 33761
(727) 669-1600
English, Russian, Spanish
M-T 10am-9pm
W-F 10am-9pm
S 10am - 9pm, Su 11am - 6pm
# DN16377 Krasnov, Rostislav
NPI: 1942267935 LIC: DN16377
CERTIFICATIONS :
#CHC10109
DOH - Pinellas County Health
Department
205 Dr. Martin Luther King St No.
Saint Petersburg, FL 33701
(727) 824-6900
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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 :
#CHC10125
DOH - Pinellas County Health
Department
8751 Ulmerton Rd
Largo, FL 33771
(727) 524-4410
Spanish, English
M-T 8am-5pm
W-F 8am-5pm
# DN12823 Beers, Eda
NPI: 1437118460 LIC: DN12823
CERTIFICATIONS :
• Inhalation Sedation
# DN12874 Chekan, Theodore
NPI: 1992750426 LIC: DN12874
CERTIFICATIONS :
# DN13061 Engelman, Sharon
NPI: 1215996384 LIC: DN13061
CERTIFICATIONS :
# DN18300 Gatons, Yelena
NPI: 1326202474 LIC: DN18300
CERTIFICATIONS :
# DN11984 Gonzalez, Jose
NPI: 1992706691 LIC: DN11984
CERTIFICATIONS :
# DN12521 Lense, Pedro
NPI: 1154380913 LIC: DN12521
CERTIFICATIONS :
# DN11690 Saraydar, Haychell
NPI: 1750343257 LIC: DN11690
CERTIFICATIONS :
# DN19476 Thomas, Kelly
NPI: 1821374828 LIC: DN19476
CERTIFICATIONS :
# DN11179 Wong, Elaine
NPI: 1295794360 LIC: DN11179
CERTIFICATIONS :
#CHC10126
DOH - Pinellas County Health
Department
12420 130Th Ave North
Largo, FL 33774
(727) 824-6900
Spanish, English
T 9am - 5pm
# 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
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
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
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 :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#010933
E & G Family Dentistry, Inc
28913 Us Hwy 19 N
Clearwater, FL 33761
(727) 772-8772
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
English, Spanish
M-T 8am-5pm
W 10am-6pm, Th 8am-5pm,F
7am-4pm
# DN22099 Alter, Jason
NPI: 1750734703 LIC: DN22099
CERTIFICATIONS :
# DN22753 Azizkhani, Nahal
NPI: 1366962649 LIC: DN22753
CERTIFICATIONS :
# DN18737 Luce, Amy
NPI: 1770888059 LIC: DN18737
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
#010982
Great Expressions Dental Centers
2938 West Bay Drive Ste C
Belleair Bluffs, FL 33770
(727) 584-5548
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 :
#011004
Great Expressions Dental Centers
35176 Us Hwy 19 North
Palm Harbor, FL 34684
(727) 723-1400
English
M-T 8am-5pm
W-F 8am-5pm
# DN22775 Bala, Joanna
NPI: 1144743774 LIC: DN22775
CERTIFICATIONS :
# DN21913 Millan-Morales, Alicia
NPI: 1003266719 LIC: DN21913
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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN17816 Magazine, Joanna
NPI: 1437346376 LIC: DN17816
CERTIFICATIONS :
#011425
Greenberg Dental & Orthodontics
10472 Roosevelt Blvd North
Saint Petersburg, FL 33716
(727) 399-6938
English, Spanish, Albanian (T), Tamil
M-T 7am-3pm
W 11am-7pm, Th 8am-4pm,F
7am-3pm
# DN21327 Dockus, Matthew
NPI: 1013399013 LIC: DN21327
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
#012474
Greenberg Dental & Orthodontics
2045 Gulf To Bay Blvd Ste B
Clearwater, FL 33765
(727) 474-0211
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 :
# DN22130 Arditi, Sibel
NPI: 1821441445 LIC: DN22130
CERTIFICATIONS :
# DN22132 Bacchelli, Lara
NPI: 1740633718 LIC: DN22132
CERTIFICATIONS :
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN21327 Dockus, Matthew
NPI: 1013399013 LIC: DN21327
CERTIFICATIONS :
# DN23467 Folks, Garrett
NPI: 1437643137 LIC: DN23467
CERTIFICATIONS :
• Inhalation Sedation
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN23380 Hernandez Moreno, Rosa
NPI: 1124510508 LIC: DN23380
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
# DN22832 Letteri, Nicholas
NPI: 1992237937 LIC: DN22832
CERTIFICATIONS :
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN23461 Musselman, Robert
NPI: 1588158505 LIC: DN23461
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
# DN23761 Rhodes, Anson
NPI: 1588155410 LIC: DN23761
CERTIFICATIONS :
# DN23563 Robinson Maita, Santos
NPI: 1063999613 LIC: DN23563
CERTIFICATIONS :
# DN21267 Roque, Jose
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 122 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1093111767 LIC: DN21267
CERTIFICATIONS :
• Inhalation Sedation
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# DN24318 Treyz, Carl
NPI: 1679133276 LIC: DN24318
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#013935
Greenberg Dental & Orthodontics
3711 49Th St North
Saint Petersburg, FL 33710
(727) 547-3603
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 :
# DN21327 Dockus, Matthew
NPI: 1013399013 LIC: DN21327
CERTIFICATIONS :
# DN23467 Folks, Garrett
NPI: 1437643137 LIC: DN23467
CERTIFICATIONS :
• Inhalation Sedation
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN23380 Hernandez Moreno, Rosa
NPI: 1124510508 LIC: DN23380
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
# DN22832 Letteri, Nicholas
NPI: 1992237937 LIC: DN22832
CERTIFICATIONS :
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN23461 Musselman, Robert
NPI: 1588158505 LIC: DN23461
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
# 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
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
CERTIFICATIONS :
# DN22755 Shah, Priya
NPI: 1528584919 LIC: DN22755
CERTIFICATIONS :
# DN24318 Treyz, Carl
NPI: 1679133276 LIC: DN24318
CERTIFICATIONS :
# 019030588 Trivedi, Mehulkumar
NPI: 1265801294 LIC: 019030588
CERTIFICATIONS :
#012053
Greenberg Dental & Orthodontics
PA
2950 34Th St.
Saint Petersburg, FL 33711
(727) 547-3603
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN23995 Goulding, Mark
NPI: 1912493677 LIC: DN23995
CERTIFICATIONS :
# DN22832 Letteri, Nicholas
NPI: 1992237937 LIC: DN22832
CERTIFICATIONS :
#017047
Greenberg Dental & Orthodontics,
PA
12963 Walsingham Road
Largo, FL 33774
(727) 265-3307
English, Spanish
M-T 8am-4pm
W-Th 11am-7pm
# DN22130 Arditi, Sibel
NPI: 1821441445 LIC: DN22130
CERTIFICATIONS :
#010840
St. Petersburg Dental Clinic
9200 113Th Street N.
Seminole, FL 33772
(727) 394-6064
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 :
#011546
Tyrone Square Mall Dental PA
6747 Tyrone Square
Saint Petersburg, FL 33710
(727) 345-6100
English, Russian, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN23637 Lopez, Catherine
NPI: 1558841890 LIC: DN23637
CERTIFICATIONS :
ORAL SURGEON
#012474
Greenberg Dental & Orthodontics
2045 Gulf To Bay Blvd Ste B
Clearwater, FL 33765
(727) 474-0211
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# DN19281 Guerra-Andrade, Andres
NPI: 1669610044 LIC: DN19281
CERTIFICATIONS :
• General Anesthesia
# DN16923 Lawson, Scott
NPI: 1467470781 LIC: DN16923
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
CERTIFICATIONS :
• Board Certification
• General Anesthesia
• Inhalation Sedation
#013935
Greenberg Dental & Orthodontics
3711 49Th St North
Saint Petersburg, FL 33710
(727) 547-3603
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN10476 Digney, J. Michael
NPI: 1780792770 LIC: DN10476
CERTIFICATIONS :
• General Anesthesia
# DN19281 Guerra-Andrade, Andres
NPI: 1669610044 LIC: DN19281
CERTIFICATIONS :
• General Anesthesia
# 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
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
(813) 968-2483
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN23098 Angeloni, Mark
NPI: 1881047843 LIC: DN23098
CERTIFICATIONS :
#011221
Florida Orthodontic Associates,
LLC
5885 Central Ave
Saint Petersburg, FL 33710
(813) 968-2483
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN10571 McDowell, Ernest
NPI: 1275682023 LIC: DN10571
CERTIFICATIONS :
• Board Certification
#012474
Greenberg Dental & Orthodontics
2045 Gulf To Bay Blvd Ste B
Clearwater, FL 33765
(727) 474-0211
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22319 Hasan, Shadiya
NPI: 1376033654 LIC: DN22319
CERTIFICATIONS :
#013935
Greenberg Dental & Orthodontics
3711 49Th St North
Saint Petersburg, FL 33710
(727) 547-3603
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN22319 Hasan, Shadiya
NPI: 1376033654 LIC: DN22319
CERTIFICATIONS :
#012053
Greenberg Dental & Orthodontics
PA
2950 34Th St.
Saint Petersburg, FL 33711
(727) 547-3603
English, Spanish
M-T 11am-7pm
W-F 7am-3pm
# DN20464 Guloy, Robertzon*
NPI: 1659533883 LIC: DN20464
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
English
M-T 8am-5pm
W-Th 8am-5pm
# DN20141 Mann, Nicholas
NPI: 1508205139 LIC: DN20141
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#022289
Countryside Mall Dental PA
27001 Us Highway 19 N, Ste 1031B
Clearwater, FL 33761
(727) 669-1600
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# 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) 350-3336
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN13950 Blankenship, Susan
NPI: 1679699383 LIC: DN13950
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
(727) 325-6485
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
English, Spanish
M-T 8am-5pm
W 10am-6pm, Th 8am-5pm,F
7am-4pm
# DN19207 Bui, LoanAnh
NPI: 1003883422 LIC: DN19207
CERTIFICATIONS :
• Inhalation Sedation
#012474
Greenberg Dental & Orthodontics
2045 Gulf To Bay Blvd Ste B
Clearwater, FL 33765
(727) 474-0211
English, Spanish
M-T 8am-4pm
W-F 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
#013935
Greenberg Dental & Orthodontics
3711 49Th St North
Saint Petersburg, FL 33710
(727) 547-3603
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
#020350
Harp Family Dentistry
31067 Us Highway 19N
Palm Harbor, FL 34684
(727) 304-5483
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
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 :
• Inhalation Sedation
#011379
Richard W. Blake, DDS, PA
2701 Park Drive, Ste 1
Clearwater, FL 33763
(727) 796-2187
English, Spanish
M 7am - 4pm,
Th-F 7am-3pm
# DN5634 Blake, Richard
NPI: 1912921867 LIC: DN5634
CERTIFICATIONS :
• Board Certification
• Inhalation Sedation
• Pediatric Conscious Sedation
#010946
Susan D. Blankenship, DMD
35036 Us Highway 19 N
Palm Harbor, FL 34684
(727) 446-4699
English, Spanish
M-T 8am-5pm
W-Th 8am-5pm
# DN13950 Blankenship, Susan
NPI: 1679699383 LIC: DN13950
CERTIFICATIONS :
• Inhalation Sedation
PROSTHODONTICS
#010852
Great Expressions Dental Centers
400 Carillon Parkway, Ste 120
St Petersburg, FL 33716
(727) 299-0728
English, Spanish
M-T 8am-5pm
W 10am-6pm, Th 8am-5pm,F
7am-4pm
# 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
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
(863) 635-4891
English, Spanish, Creoles and Pidgins,
English-based(other), French
M-T 7am-5pm
W-F 7am-5pm
# 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
Spanish, English
M-T 7am-5pm
W-F 7am-5pm
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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 :
#FQHC020824
Central Florida Health Care, Inc
601 S. Florida Ave, Ste 6
Lakeland, FL 33801
(866) 234-8534
English, Spanish, Creoles and Pidgins,
French-based(other)
M-T 7am-6pm
Th-F 7am-6pm
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
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 :
# DN18203 Geller, Robert
NPI: 1669503280 LIC: DN18203
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 :
#FQHC021227
Central Florida Health Care, Inc
705 Ingraham Ave
Haines City, FL 33844
(863) 438-6900
English, Spanish, Creoles and Pidgins,
English-based(other)
M-T 7am-6pm
W-Th 7am-6pm
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
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 :
# DN18203 Geller, Robert
NPI: 1669503280 LIC: DN18203
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 :
#FQHC011909
Central Florida Health Care, Inc.
1514 1St St North
Winter Haven, FL 33881
(866) 234-8534
Spanish, English, Creoles and Pidgins,
French-based(other)
M-T 7am-6pm
W-Th 7am-6pm
# DN12871 Cardenas, Carlos
NPI: 1568649804 LIC: DN12871
CERTIFICATIONS :
# DN18203 Geller, Robert
NPI: 1669503280 LIC: DN18203
CERTIFICATIONS :
#FQHC012686
Central Florida Health Care, Inc.
106 Nw 9Th Ave
Mulberry, FL 33860
(863) 425-6200
English, Spanish
M-T 7am-6pm
W-F 7am-6pm
# DN22773 Aiyede, Onize
NPI: 1306295712 LIC: DN22773
CERTIFICATIONS :
#FQHC015864
Central Florida Health Care, Inc.
201 Magnolia Ave Sw
Winter Haven, FL 33880
www.cfhconline.org
(866) 234-8534
English, Spanish, Creoles and Pidgins,
French-based(other)
M-T 7am-5pm
W-F 7am-5pm
# HAD80 Antony, Archana
NPI: 1851607766 LIC: HAD80
CERTIFICATIONS :
# DN13255 Cooper, Angela
NPI: 1912994914 LIC: DN13255
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 :
# DN17405 Ward, Tasha
NPI: 1528087871 LIC: DN17405
CERTIFICATIONS :
#014183
Children and Teen Dental Group
of Florida
225 Imperial Blvd
Lakeland, FL 33803
(863) 644-4739
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
# 22DI02680600 Hernandez,
Christine
NPI: 1891216784 LIC: 22DI02680600
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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Children and Teen Dental Group
of Florida
727 3Rd Street Sw
Winter Haven, FL 33880
(863) 644-4739
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
English
T 8am - 4pm
W-Th 8am-4pm
# 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
English, Spanish
M-T 7am-5pm
W 7am-3pm, Th 7am-5pm
# DN12624 Dire, 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
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
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
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
Spanish, English
M-T 8am-5pm
W 7am-5pm, Th 8am-5pm,F 7am-5pm
# DN11009 Ebner, Stephen
NPI: 1578652442 LIC: DN11009
CERTIFICATIONS :
• Inhalation Sedation
# DN15480 Rodriguez, Ana
NPI: 1184835985 LIC: DN15480
CERTIFICATIONS :
• Inhalation Sedation
# DN19400 Santos, Luis
NPI: 1821152232 LIC: DN19400
CERTIFICATIONS :
• Inhalation Sedation
#CHC10107
DOH - Polk County Health
Department
3241 Lakeland Hills Blvd
Lakeland, FL 33805
(863) 519-7910
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
Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 7am - 3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
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 127 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN20164 Gollob, Harrison
NPI: 1891134441 LIC: DN20164
CERTIFICATIONS :
• Inhalation Sedation
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#014212
Greenberg Dental & Orthodontics
4969 Us Hwy 98 N
Lakeland, FL 33809
(863) 614-0044
English, Spanish, Tagalog
M 7am - 6pm, T 8am - 6pm
Th-F 7am-3pm
S 7am - 1pm
# DN19348 Fidy, Ramez
NPI: 1629362686 LIC: DN19348
CERTIFICATIONS :
# DN20411 Rivera, Abneris
NPI: 1467710160 LIC: DN20411
CERTIFICATIONS :
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
CERTIFICATIONS :
#016183
Greenberg Dental & Orthodontics
2926 S. Florida Ave
Lakeland, FL 33803
(863) 226-6269
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
CERTIFICATIONS :
#019423
Greenberg Dental & Orthodontics
42613 Highway 27
Davenport, FL 33837
(863) 824-7098
English, Spanish
M 10am - 6pm, T 7am - 3pm
W 7am-3pm, Th 10am-6pm,F
7am-3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN19348 Fidy, Ramez
NPI: 1629362686 LIC: DN19348
CERTIFICATIONS :
#020828
Greenberg Dental & Orthodontics
7070 Cypress Gardens Blvd
Winter Haven, FL 33884
(863) 259-4026
English, Spanish
M-T 8am-4pm
W-Th 10am-6pm
# DN19348 Fidy, Ramez
NPI: 1629362686 LIC: DN19348
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22803 Patel, Devesh
NPI: 1306367420 LIC: DN22803
CERTIFICATIONS :
# DN17392 Sehgal, Mamta
NPI: 1750393112 LIC: DN17392
CERTIFICATIONS :
#012373
Greenberg Dental & Orthodontics,
PA
1475 6Th St Nw
Winter Haven, FL 33881
(863) 226-0261
English, Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 7am - 1pm
# DN23294 Brambila, Danielle
NPI: 1720577703 LIC: DN23294
CERTIFICATIONS :
• Inhalation Sedation
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
#007727
Mulberry Dental Care, Inc
105 N. Church Ave
Mulberry, FL 33860
(863) 869-8888
English, Farsi, French, Persian (T),
Spanish
M-T 8am-4pm
W-Th 8am-4pm
# DN13817 Farzaneh, Masoud
NPI: 1669544540 LIC: DN13817
CERTIFICATIONS :
#007662
Philip Contreras
1251 Ariana Street
Lakeland, FL 33803
(863) 688-9884
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
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
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN16966 Gaitan, German
NPI: 1164543351 LIC: DN16966
CERTIFICATIONS :
ENDODONTICS
#019423
Greenberg Dental & Orthodontics
42613 Highway 27
Davenport, FL 33837
(863) 824-7098
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 :
# DN19593 Mir, Hamza
NPI: 1194094938 LIC: DN19593
CERTIFICATIONS :
ORAL SURGEON
# DN19573 Adams, Bryan
NPI: 1861557837 LIC: DN19573
CERTIFICATIONS :
• General Anesthesia
• Inhalation Sedation
#022551
Tampa Bay Institute of Oral
Surgery & Dental Implants
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
1301 Grasslands Blvd, Ste 200
Lakeland, FL 33803
(863) 648-6555
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
PEDIATRIC DENTISTRY
#015103
Greenberg Dental - Poinciana
1096 Cypress Pkwy
Kissimmee, FL 34759
(407) 933-8222
Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 7am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#014212
Greenberg Dental & Orthodontics
4969 Us Hwy 98 N
Lakeland, FL 33809
(863) 614-0044
English, Spanish, Tagalog
M 7am - 6pm, T 8am - 6pm
Th-F 7am-3pm
S 7am - 1pm
# DN19477 Ojeda Jr., Juan
NPI: 1861786949 LIC: DN19477
CERTIFICATIONS :
• Inhalation Sedation
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#016183
Greenberg Dental & Orthodontics
2926 S. Florida Ave
Lakeland, FL 33803
(863) 226-6269
English, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN19477 Ojeda Jr., Juan
NPI: 1861786949 LIC: DN19477
CERTIFICATIONS :
• Inhalation Sedation
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#019423
Greenberg Dental & Orthodontics
42613 Highway 27
Davenport, FL 33837
(863) 824-7098
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
# 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
#012373
Greenberg Dental & Orthodontics,
PA
1475 6Th St Nw
Winter Haven, FL 33881
(863) 226-0261
English, Spanish
M-T 7am-7pm
W-Th 7am-7pm
S 7am - 1pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
PERIODONTICS
#019423
Greenberg Dental & Orthodontics
42613 Highway 27
Davenport, FL 33837
(863) 824-7098
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 :
PUTNAM COUNTY
DENTIST
#FQHC010441
Azalea Health
2503 President Street
Palatka, FL 32177
(386) 328-7638
English, Spanish
M-T 8am-7pm
W-Th 8am-7pm
S 8am - 5pm
# DN21424 Budzinski, Volha
NPI: 1588047468 LIC: DN21424
CERTIFICATIONS :
# HAD56 Krotzinger, Mary
NPI: 1992796973 LIC: HAD56
CERTIFICATIONS :
#CHC10218
DOH - Putnam County Health
Department
2801 Kennedy Street
Palatka, FL 32177
(386) 326-3336
English, Spanish
M-T 8am-5pm
W 8am-6pm, Th 9am-6pm,F 8am-5pm
# DN18662 Williams, Richard
NPI: 1922231125 LIC: DN18662
CERTIFICATIONS :
SAINT JOHNS COUNTY
DENTIST
#FQHC016587
Azalea Health
250 State Rd 207
Saint Augustine, FL 32084
(904) 824-3322
English, Spanish
M-T 8am-7pm
W-Th 8am-7pm
# DN15770 Halady, Pratima
NPI: 1720256811 LIC: DN15770
CERTIFICATIONS :
#CHC015415
DOH - Saint Johns County Health
Department
200 San Sebastian View
Saint Augustine, FL 32084
(904) 209-3250
English, Spanish, Sign Languages
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 129 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
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
English, Spanish, Polish
M-T 7am-4pm
W-Th 7am-4pm
# DN11948 Clark, Patricia
NPI: 1871677476 LIC: DN11948
CERTIFICATIONS :
#011012
Great Expressions Dental Centers
9 St. Johnson Medical Park, Ste B
Saint Augustine, FL 32086
(904) 797-4108
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
English, Spanish
M-T 10am-6pm
W-F 7am-3pm
# DN19360 Acevedo-Decandis,
Stephanie
NPI: 1962797498 LIC: DN19360
CERTIFICATIONS :
• Inhalation Sedation
# DN22756 Chung, Ada
NPI: 1801300942 LIC: DN22756
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN20798 Freeman, Michael
NPI: 1023351020 LIC: DN20798
CERTIFICATIONS :
# DN23406 Gregory, Allison
NPI: 1518459437 LIC: DN23406
CERTIFICATIONS :
# DN23359 Houston, Kyle
NPI: 1841784238 LIC: DN23359
CERTIFICATIONS :
# DN23282 Isaza, Sebastian
NPI: 1659892743 LIC: DN23282
CERTIFICATIONS :
# DN22097 Mabardi, Nicolas
NPI: 1093168510 LIC: DN22097
CERTIFICATIONS :
# DN23386 Park, Chin
NPI: 1063904449 LIC: DN23386
CERTIFICATIONS :
# DN18785 Patel, Viral
NPI: 1881917540 LIC: DN18785
CERTIFICATIONS :
• Inhalation Sedation
# DN21922 Six, Denise
NPI: 1104277722 LIC: DN21922
CERTIFICATIONS :
# DN24117 Valiente, Esteban
NPI: 1144889494 LIC: DN24117
CERTIFICATIONS :
# DN23403 Veazey, Sarah
NPI: 1841783222 LIC: DN23403
CERTIFICATIONS :
• Inhalation Sedation
# 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
English, Spanish
M 10am - 6pm, T 7am - 3pm
Th-F 7am-3pm
S 8am - 2pm
# DN23698 Asadi, Siraj
NPI: 1235612730 LIC: DN23698
CERTIFICATIONS :
# DN12124 Barrett, Steven
NPI: 1811957046 LIC: DN12124
CERTIFICATIONS :
# DN23603 Doshi, Rajvi
NPI: 1861979486 LIC: DN23603
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN7501 Greenberg, Andrew
NPI: 1740240696 LIC: DN7501
CERTIFICATIONS :
# DN22205 Lidhran, Paraminderpal
NPI: 1609322270 LIC: DN22205
CERTIFICATIONS :
# DN21362 Poblenz, Charles
NPI: 1134501141 LIC: DN21362
CERTIFICATIONS :
# DN22077 Soni, Juhi
NPI: 1821441379 LIC: DN22077
CERTIFICATIONS :
ENDODONTICS
#011012
Great Expressions Dental Centers
9 St. Johnson Medical Park, Ste B
Saint Augustine, FL 32086
(904) 797-4108
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 :
PEDIATRIC DENTISTRY
# DN20924 Sipe, Anna
NPI: 1750588182 LIC: DN20924
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
SAINT LUCIE COUNTY
DENTIST
#CHC015267
DOH - Saint Lucie County Health
Department
537 Nw Lake Whitney Place, Ste 101
Port Saint Lucie, FL 34986
(772) 462-3800
English, Spanish, Creoles and Pidgins
(other), French
M-T 8am-5pm
W-Th 8am-5pm
S 8am - 2pm
# DN10216 Adu-Tutu, Michael
NPI: 1952362931 LIC: DN10216
CERTIFICATIONS :
# DN14245 Ahmad, Haleemah
NPI: 1437240835 LIC: DN14245
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
English, Spanish, Creoles and Pidgins
(other)
M 8am - 6pm, T 8am - 8pm
W-F 8am-8pm
S 8am - 5pm
# DN14000 Naryshkin, George
NPI: 1730395773 LIC: DN14000
CERTIFICATIONS :
# DN18121 Palacios, Eric
NPI: 1376778084 LIC: DN18121
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 :
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
#010866
Great Expressions Dental Centers
7554 S. Us Highway 1, Ste 13
Port Saint Lucie, FL 34952
(772) 343-1762
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
S 8am - 12pm
# DN18775 Luba, Kevin
NPI: 1801040399 LIC: DN18775
CERTIFICATIONS :
# DN22985 McCourt, Sarah
NPI: 1083139653 LIC: DN22985
CERTIFICATIONS :
• Inhalation Sedation
# 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
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
# DN20845 Bradley, Alijah
NPI: 1003224148 LIC: DN20845
CERTIFICATIONS :
# DN10457 Broggi, Edward
NPI: 1215955190 LIC: DN10457
CERTIFICATIONS :
# DN24614 Cerrutti, Juan
NPI: 1992233167 LIC: DN24614
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
PEDIATRIC DENTISTRY
#010866
Great Expressions Dental Centers
7554 S. Us Highway 1, Ste 13
Port Saint Lucie, FL 34952
(772) 343-1762
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
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
English
M 8am - 5pm,
W-Th 8am-5pm
# DN18812 Fishbein, Benjamin
NPI: 1144543620 LIC: DN18812
CERTIFICATIONS :
# DN22495 Howle, Sarah
NPI: 1215477146 LIC: DN22495
CERTIFICATIONS :
#019095
Fishbein Orthodontics
7552 Navarre Pkwy Unit 57
Navarre, FL 32566
(850) 477-1089
English
T 8am - 5pm
# DN18812 Fishbein, Benjamin
NPI: 1144543620 LIC: DN18812
CERTIFICATIONS :
# DN22495 Howle, Sarah
NPI: 1215477146 LIC: DN22495
CERTIFICATIONS :
SARASOTA COUNTY
DENTIST
#015890
Beneva Dental Care
5917 S. Beneva Road
Sarasota, FL 34238
(941) 924-2939
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
(941) 529-0100
English, Spanish
M-T 7am-4pm
W-F 7am-4pm
# DN16242 Misischia, William
NPI: 1619199973 LIC: DN16242
CERTIFICATIONS :
• Inhalation Sedation
#FQHC019490
CenterPlace Health Inc.
2200 Ringling Blvd
Sarasota, FL 34237
(941) 861-2935
English, Spanish
M-T 7am-5pm
W-F 7am-5pm
# 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
English, Spanish
M-T 7am-4pm
W-Th 7am-4pm
# DN21483 DeVilliers, 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 131 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1669568861 LIC: DN21483
CERTIFICATIONS :
• Inhalation Sedation
# DN23710 Houston, James
NPI: 1972661734 LIC: DN23710
CERTIFICATIONS :
• Inhalation Sedation
# DN14316 Jenkins, James
NPI: 1861701906 LIC: DN14316
CERTIFICATIONS :
• Inhalation Sedation
# DN16242 Misischia, William
NPI: 1619199973 LIC: DN16242
CERTIFICATIONS :
• Inhalation Sedation
#013443
F.A. Skordas, DDS, MS, PL
7129 Curtiss Ave, Ste #2
Sarasota, FL 34231
(941) 922-8811
English, Japanese
M-T 9am-5pm
W-Th 9am-5pm
S 8am - 3pm
# DN13645 Skordas, Fotios
NPI: 1124308812 LIC: DN13645
CERTIFICATIONS :
#013934
Greenberg Dental & Orthodontics
4280 Bee Ridge Rd.
Sarasota, FL 34233
(941) 363-6381
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
S 7am - 2pm
# DN22658 Laurey, Violet
NPI: 1194254789 LIC: DN22658
CERTIFICATIONS :
• Inhalation Sedation
# DN21456 Mora, Viviana
NPI: 1811372154 LIC: DN21456
CERTIFICATIONS :
# DN21267 Roque, Jose
NPI: 1093111767 LIC: DN21267
CERTIFICATIONS :
• Inhalation Sedation
#022695
North Port Smiles
13801 Tamiami Trail, Ste B
North Port, FL 34287
(941) 200-5812
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
English, Farsi, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN14696 Arshadi, Eftekhar
NPI: 1497851851 LIC: DN14696
CERTIFICATIONS :
ORTHODONTIST
#016110
Florida Pediatric Dental Associates
5561 Broadcast Ct
Sarasota, FL 34240
www.allsmiles.com
(941) 727-0025
English, Spanish
M-T 8am-5pm
W-F 8am-5pm
# DN10571 McDowell, Ernest
NPI: 1275682023 LIC: DN10571
CERTIFICATIONS :
• Board Certification
PEDIATRIC DENTISTRY
#FQHC019490
CenterPlace Health Inc.
2200 Ringling Blvd
Sarasota, FL 34237
(941) 861-2935
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
English, Spanish
M-T 8am-1pm
# DN5961 Bowles, David
NPI: 1649342635 LIC: DN5961
CERTIFICATIONS :
• General Anesthesia
#016110
Florida Pediatric Dental Associates
5561 Broadcast Ct
Sarasota, FL 34240
www.allsmiles.com
(941) 727-0025
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
#013934
Greenberg Dental & Orthodontics
4280 Bee Ridge Rd.
Sarasota, FL 34233
(941) 363-6381
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
S 7am - 2pm
# DN21050 Lee, Sara
NPI: 1740673185 LIC: DN21050
CERTIFICATIONS :
• Inhalation Sedation
SEMINOLE COUNTY
DENTIST
#011385
Affordable Dentist, LLC
3228 W Sr 426, Ste 1000
Oviedo, FL 32765
(407) 678-3330
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
(407) 831-4077
English, Farsi, Serbian, 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
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
(407) 261-0201
English, Russian, Spanish
M-T 8am-4pm
W-F 8am-4pm
# DN7894 Cullen, William
NPI: 1013110535 LIC: DN7894
CERTIFICATIONS :
• Inhalation Sedation
# DN23099 Rodriguez, Iveliss
NPI: 1962971200 LIC: DN23099
CERTIFICATIONS :
#012921
Amazing Smile, LLC
2417 S. French Ave
Sanford, FL 32771
(407) 321-5010
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN20701 Clemente, Evelyn
NPI: 1952715443 LIC: DN20701
CERTIFICATIONS :
#018679
Bright Smile Dental at Oviedo,
Inc.
945 City Plaza Way #1051
Oviedo, FL 32765
(407) 542-8383
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
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
(407) 665-3346
English, Arabic, Gujarati, Hindi,
Spanish
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
English, Spanish
M 8am - 4pm, T 10am - 5pm
W 10am-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
English, Spanish
M-T 7am-7pm
Th-F 7am-3pm
S 8am - 3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015133
Greenberg Dental - Casselberry
879 State Rd 436
Casselberry, FL 32707
(407) 767-7600
English, Spanish, Gujarati, Hindi
M 9am - 5pm, T 11am - 7pm
W-F 7am-3pm
S 7am - 1pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#007474
Greenberg Dental - Lake Mary
3639 S. Orlando Dr
Sanford, FL 32773
(407) 347-4814
Spanish
M-T 10am-6pm
W-F 7am-3pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015108
Greenberg Dental - Oviedo
1500 Alafaya Trail, Ste # 1064
Oviedo, FL 32765
(407) 977-1600
Spanish, Vietnamese
M-T 9am-7pm
W-Th 11am-7pm
S 8am - 1pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#015131
Greenberg Dental - Sanford
819 E. First St, Ste 9
Sanford, FL 32771
(407) 323-8180
English, Spanish, Filipino; Pilipino,
Tagalog
M-T 10am-6pm
W 8am-4pm, Th 10am-6pm,F
8am-4pm
# DN23364 Collier, Richard
NPI: 1154813749 LIC: DN23364
CERTIFICATIONS :
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN21816 Shields, Nastassia
NPI: 1093198301 LIC: DN21816
CERTIFICATIONS :
#007864
James Ho, DMD PA
430 Waymont Ct., Ste 110
Lake Mary, FL 32746
(407) 322-1688
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
English, Spanish
M-T 8am-4pm
W 8am-4pm, Th 9am-5pm,F 9am-2pm
# DN12237 Figaro, Mark
NPI: 1952516965 LIC: DN12237
CERTIFICATIONS :
#FQHC019164
Orange Blossom Family Health
225 N. Kennel Road
Sanford, FL 32771
(407) 428-5751
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
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
English, Arabic, Hindi, Japanese,
Spanish
# DN8196 Kathuria, Prem
NPI: 1336300763 LIC: DN8196
CERTIFICATIONS :
#011087
Sanford Plaza Dental Center
2921 S Orlando Drive, Ste 146
Sanford, FL 32773
(407) 322-9992
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
English
M 9am - 5pm,
W 9am-12pm,
# DN6455 Sherman, Willie
NPI: 1619063625 LIC: DN6455
CERTIFICATIONS :
ORTHODONTIST
#011088
Advanced Orthodontic Practices
100 Lake Shore Drive, Ste 104
Altamonte Springs, FL 32714
(407) 628-9523
English
M-T 8am-5pm
W 8am-5pm,
# DN8121 Bryant Jr., Walter
NPI: 1073723003 LIC: DN8121
CERTIFICATIONS :
PEDIATRIC DENTISTRY
#015134
Greenberg Dental - Altamonte
Springs
926 Great Pond Dr, Ste 1000
Altamonte Springs, FL 32714
(407) 862-0444
English, Spanish
M-T 7am-7pm
Th-F 7am-3pm
S 8am - 3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015133
Greenberg Dental - Casselberry
879 State Rd 436
Casselberry, FL 32707
(407) 767-7600
English, Spanish, Gujarati, Hindi
M 9am - 5pm, T 11am - 7pm
W-F 7am-3pm
S 7am - 1pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#007474
Greenberg Dental - Lake Mary
3639 S. Orlando Dr
Sanford, FL 32773
(407) 347-4814
Spanish
M-T 10am-6pm
W-F 7am-3pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015108
Greenberg Dental - Oviedo
1500 Alafaya Trail, Ste # 1064
Oviedo, FL 32765
(407) 977-1600
Spanish, Vietnamese
M-T 9am-7pm
W-Th 11am-7pm
S 8am - 1pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015131
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Greenberg Dental - Sanford
819 E. First St, Ste 9
Sanford, FL 32771
(407) 323-8180
English, Spanish, Filipino; Pilipino,
Tagalog
M-T 10am-6pm
W 8am-4pm, Th 10am-6pm,F
8am-4pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
SUMTER COUNTY
DENTIST
#015271
Central FL Dental Associates, LLC
11905 N Us Highway 301
Oxford, FL 34484
(352) 748-9688
English, Spanish
M-T 9am-5pm
W-F 9am-5pm
# DN12237 Figaro, Mark
NPI: 1952516965 LIC: DN12237
CERTIFICATIONS :
#FQHC10255
Langley Health Services
1389 S. U.S. Hwy 301
Sumterville, FL 33585
(352) 793-5900
English, Spanish
M-T 7am-6pm
W-F 7am-6pm
# DN19878 Clinton, Edna
NPI: 1376853929 LIC: DN19878
CERTIFICATIONS :
• Inhalation Sedation
# DN23356 Lutes, Meaghan
NPI: 1760974554 LIC: DN23356
CERTIFICATIONS :
# DN20142 Matthews, Irina
NPI: 1891135331 LIC: DN20142
CERTIFICATIONS :
# DN21667 Pirie, Edward
NPI: 1255705752 LIC: DN21667
CERTIFICATIONS :
# DN15250 Vavruska, Julie
NPI: 1992798649 LIC: DN15250
CERTIFICATIONS :
• Inhalation Sedation
SUWANNEE COUNTY
DENTIST
#CHC010310
DOH - Suwannee County Health
Department
915 Nobles Ferry Rd
Live Oak, FL 32064
(386) 362-2708
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
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
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.northfloridamedicalcenters.org
(850) 223-2578
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
English, Spanish
M-T 10am-5pm
W-F 10am-5pm
# DN16520 Ballet, Lourdes
NPI: 1255517850 LIC: DN16520
CERTIFICATIONS :
#CHC014791
DOH - Volusia County Health
Department
775 Harley Strickland Drive, Ste 110
Orange City, FL 32763
(386) 274-0896
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
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
English, Spanish
M-T 8am-5pm
W 8am-2pm, Th 8am-5pm,F 8am-2pm
# DN9896 Quarterman, Robbin
NPI: 1962539197 LIC: DN9896
CERTIFICATIONS :
#FQHC020653
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
Family Health Source
1205 Woodland Blvd, Ste 5
Deland, FL 32720
(386) 888-4911
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
English, Spanish
M 8am - 4pm, T 10am - 6pm
W 8am-4pm, Th 8am-5pm,F 8am-4pm
S 8am - 12pm
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
# DN24250 Patel, Nishka
NPI: 1134788367 LIC: DN24250
CERTIFICATIONS :
#015114
Greenberg Dental - Deland
2641 S. Woodland Blvd
Deland, FL 32720
(386) 738-7441
English, Spanish
M-T 8am-7pm
W-F 7am-4pm
# DN23294 Brambila, Danielle*
NPI: 1720577703 LIC: DN23294
CERTIFICATIONS :
• Inhalation Sedation
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
#015117
Greenberg Dental - Port Orange
4003 S. Nova Rd
Port Orange, FL 32127
(386) 763-2000
English, Spanish
M 10am - 6pm, T 8am - 4pm
W-F 8am-4pm
S 8am - 2pm
# DN22547 Cuellar Gonzalez, Hector
NPI: 1831623073 LIC: DN22547
CERTIFICATIONS :
# DN22845 Estrada, Manuel
NPI: 1306378146 LIC: DN22845
CERTIFICATIONS :
• Inhalation Sedation
# DN21317 Feng, Connie
NPI: 1689057432 LIC: DN21317
CERTIFICATIONS :
# DN23110 Greenberg, Adam
NPI: 1295240646 LIC: DN23110
CERTIFICATIONS :
# DN22743 Hoang, Nhon
NPI: 1518472547 LIC: DN22743
CERTIFICATIONS :
#010841
Terry C. Blanks, Jr, DDS, PA
895 S. Dexter Ave
Deland, FL 32720
(386) 738-2002
English, Spanish
M 9am - 3pm, T 9am - 5pm
# DN5526 Blanks, Terry
NPI: 1154660819 LIC: DN5526
CERTIFICATIONS :
• Conscious Sedation
PEDIATRIC DENTISTRY
#011282
Daytona Pediatric Dentistry
1021 S. Ridgewood Ave
Daytona Beach, FL 32114
(386) 304-2677
English, Spanish, Portuguese, Urdu
T 8am - 5pm
W-Th 8am-5pm
# DN13783 Chaudhry, Mubashir
NPI: 1861490864 LIC: DN13783
CERTIFICATIONS :
• Board Certification
• Conscious Sedation
• Inhalation Sedation
• Pediatric Conscious Sedation
#015109
Greenberg Dental - Daytona Beach
1515 S. Nova Rd
Daytona Beach, FL 32114
(386) 947-9318
English, Spanish
M 8am - 4pm, T 10am - 6pm
W 8am-4pm, Th 8am-5pm,F 8am-4pm
S 8am - 12pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015114
Greenberg Dental - Deland
2641 S. Woodland Blvd
Deland, FL 32720
(386) 738-7441
English, Spanish
M-T 8am-7pm
W-F 7am-4pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015130
Greenberg Dental - Deltona
777 Deltona Blvd, Ste 9
Deltona, FL 32725
(386) 574-4407
English, Spanish
M-T 8am-6pm
W-Th 8am-6pm
S 8am - 4pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#015117
Greenberg Dental - Port Orange
4003 S. Nova Rd
Port Orange, FL 32127
(386) 763-2000
English, Spanish
M 10am - 6pm, T 8am - 4pm
W-F 8am-4pm
S 8am - 2pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation Sedation
#011215
Greenberg Dental & Orthodontics
1462 W. Granada Blvd, Ste 210
Ormond Beach, FL 32174
(386) 675-1711
Spanish, English
M-T 10am-6pm
W-F 8am-4pm
# DN21046 Perez, Marina
NPI: 1568850972 LIC: DN21046
CERTIFICATIONS :
• Inhalation 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
English, Spanish
M-T 9am-5pm
W-Th 9am-5pm
# DN20210 Abarca, Marvin
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta 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 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES
NPI: 1316388820 LIC: DN20210
CERTIFICATIONS :
• Inhalation Sedation
# DN20826 Tejada, Rodolfo
NPI: 1427345057 LIC: DN20826
CERTIFICATIONS :
• Inhalation Sedation
• Pediatric Conscious Sedation
WAKULLA COUNTY
DENTIST
#CHC013453
DOH - Wakulla County Health
Department
48 Oak Street
Crawfordville, FL 32327
(850) 926-0400
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
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 :
#012992
LECOM School of Dental
Medicine - Dental Offices
101 Lecom Way
Defuniak Springs, FL 32435
(850) 951-0200
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
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 :
# 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 :
# HAD73 Pankuch, Richard
NPI: 1467452847 LIC: HAD73
CERTIFICATIONS :
# DN21660 Piorkowski, Gary
NPI: 1699705434 LIC: DN21660
CERTIFICATIONS :
# HAD69 Smith, Amy
NPI: 1831209899 LIC: HAD69
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
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
# 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
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
English
M-T 7am-5pm
W-Th 7am-5pm
# DN18661 Whitford, Drew
NPI: 1851527303 LIC: DN18661
CERTIFICATIONS :
• Inhalation Sedation
LIBERTY Dental Plan network provider rating is based on quality measures and service.
Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.
The provider directory is subject to change without notice.
Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.
If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.
To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.
El directorio de proveedores está sujeto a cambios sin previo aviso.
Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.
Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.
Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.
* Closed to new members / Cerrado para nuevos miembros.
Page 137 of 138
February, 2020
02/24/2020 v.1(2018)
Wheelchair access / Acceso para personas en silla de ruedas.
Member Services / Servicios para miembros : (833) 276-0850
Florida Medicaid Child- iBudget
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.
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Wheelchair access / Acceso para personas en silla de ruedas.