MEDICARE: DR. LISSETTE MARIA BIENES D.M.D

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	1223G0001X	General Practice Dentistry	DN11566	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275673071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISSETTE MARIA BIENES D.M.D

Provider Business Mailing Address
First Line	:	12300 SW 90TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-5158
Country	:	US
Telephone Number	:	205-252-0907
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-3632
Country	:	US
Telephone Number	:	305-221-0301
Fax Number	:	305-221-0381

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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