Healthcare Provider Details

I. General information

NPI: 1497680995
Provider Name (Legal Business Name): LILIANA HERNANDEZ CLETO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9580 BIRD RD STE A
MIAMI FL
33165-4065
US

IV. Provider business mailing address

6620 SW 12TH ST APT 2
WEST MIAMI FL
33144-4962
US

V. Phone/Fax

Practice location:
  • Phone: 786-631-3761
  • Fax:
Mailing address:
  • Phone: 786-718-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN31823
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: