Healthcare Provider Details

I. General information

NPI: 1457270225
Provider Name (Legal Business Name): LIZASO FAMILY DENTISTRY PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4999 W 8TH AVE STE 28
HIALEAH FL
33012-3409
US

IV. Provider business mailing address

4999 W 8TH AVE STE 28
HIALEAH FL
33012-3409
US

V. Phone/Fax

Practice location:
  • Phone: 305-556-6055
  • Fax: 305-556-6440
Mailing address:
  • Phone: 305-556-6055
  • Fax: 305-556-6440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: SUSANA LIZASO-RODRIGUEZ
Title or Position: DENTIST/OWNER
Credential:
Phone: 305-556-6055