MEDICARE: MALENA LEMUS RAMOS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	26230	FL

General Provider Information

NPI Number	:	1023689387
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MALENA LEMUS RAMOS DMD

Provider Business Mailing Address
First Line	:	6280 NW 112TH TER
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-2326
Country	:	US
Telephone Number	:	786-614-6145
Fax Number	:

Provider Business Practice Location Address
First Line	:	16371 SW 88TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33196-4942
Country	:	US
Telephone Number	:	305-459-3192
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2021
Last Update Date	:	07/08/2021

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