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General NPI Number Information
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NPI Number | 1265000319
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Entity Type | Individual
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Provider Name | LISETT MATA ALVAREZ DDS
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Gender | Female
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Dates
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Enumeration Date | 06/15/2021
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Last Update Date | 07/19/2023
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Provider Practice Location Address
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Address Line | 18070 S TAMIAMI TRL # 101
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City | FORT MYERS
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State | FL
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Zip | 33908-4602
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Country | US
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Telephone | 239-236-4884
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Fax |
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Provider Business Mailing Address
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Address Line | 4208 SW SANTA BARBARA PL
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City | CAPE CORAL
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State | FL
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Zip | 33914-8434
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Country | US
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Telephone | 786-916-4453
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN28432
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License Number State | FL
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