MEDICARE: DR. LIVEISYS PEDRAZA DDS

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	26867	FL

General Provider Information

NPI Number	:	1942924121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIVEISYS PEDRAZA DDS

Provider Business Mailing Address
First Line	:	9580 BIRD RD STE A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4065
Country	:	US
Telephone Number	:	786-631-3761
Fax Number	:

Provider Business Practice Location Address
First Line	:	9580 BIRD RD STE A
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165-4065
Country	:	US
Telephone Number	:	786-631-3761
Fax Number	:

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

Provider Enumeration Date	:	09/30/2022
Last Update Date	:	09/30/2022

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Directions to “ DR. LIVEISYS PEDRAZA DDS” Practice Location

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