Healthcare Provider Details

I. General information

NPI: 1629606074
Provider Name (Legal Business Name): GRACE MARIA GUZMAN LAVANDERA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 NE 127TH ST
NORTH MIAMI FL
33161-4824
US

IV. Provider business mailing address

3430 NW 19TH ST
MIAMI FL
33125-1020
US

V. Phone/Fax

Practice location:
  • Phone: 786-542-0421
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN27343
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: