MEDICARE: LISANDRA AMADOR 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	DN23409	FL

General Provider Information

NPI Number	:	1497233845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISANDRA AMADOR DMD

Provider Business Mailing Address
First Line	:	6958 W 5TH LN
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33014-4934
Country	:	US
Telephone Number	:	786-376-4879
Fax Number	:

Provider Business Practice Location Address
First Line	:	10621 N KENDALL DR
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33176-8708
Country	:	US
Telephone Number	:	305-595-1131
Fax Number	:

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

Provider Enumeration Date	:	07/29/2018
Last Update Date	:	02/05/2020

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