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NPI Code Detail

MEDICARE: LIBERTY DENTAL PLAN OF FLORIDA, INC.

MEDICARE: LIBERTY DENTAL PLAN OF FLORIDA, INC.
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
1302R00000XHealth Maintenance Organization

General Provider Information

NPI Number : 1962980433
Entity Type Code : Organization
Provider Name (Legal Business Name) : LIBERTY DENTAL PLAN OF FLORIDA, INC.
Provider Business Mailing Address
First Line : 1730 FLIGHT WAY STE 125
Second Line :
City : TUSTIN
State : CA
Zip : 92782-1828
Country : US
Telephone Number : 888-703-6999
Fax Number :
Provider Business Practice Location Address
First Line : 3109 W DR MARTIN LUTHER KING JR BLVD STE 100
Second Line :
City : TAMPA
State : FL
Zip : 33607-6219
Country : US
Telephone Number : 888-703-6999
Fax Number :
Authorized Official
Title or Position : CHIEF COMPLIANCE OFFICER
Name : MARZENA FERCZ
Credential :
Telephone Number : 888-703-6999
Provider Enumeration Date : 08/06/2018
Last Update Date : 12/02/2025

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1821576398 — LIBERTY DENTAL PLAN OF FLORIDA, INC.
Practice Location Address:
3109 W DR MARTIN LUTHER KING JR BLVD STE 100
TAMPA, FL
33607-6219
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1316425887 — LIBERTY DENTAL PLAN OF FLORIDA, INC.
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1871071340 — LIBERTY DENTAL PLAN OF FLORIDA, INC.
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33607-6219
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1780162255 — LIBERTY DENTAL PLAN OF FLORIDA, INC.
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33607-6219
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1588142053 — LIBERTY DENTAL PLAN OF FLORIDA, INC.
Practice Location Address:
3109 W DR MARTIN LUTHER KING JR BLVD STE 100
TAMPA, FL
33607-6219
Practice Phone: 888-703-6999
Practice Fax:
1598243065 — LIBERTY DENTAL PLAN OF FLORIDA, INC.
Practice Location Address:
3109 W DR MARTIN LUTHER KING JR BLVD STE 100
TAMPA, FL
33607-6219
Practice Phone: 888-703-6999
Practice Fax:

Directions to “LIBERTY DENTAL PLAN OF FLORIDA, INC. ” Practice Location

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