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General NPI Number Information
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NPI Number | 1396684031
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Entity Type | Organization
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Legal Business Name | MADISON DENTISTRY LLC
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Dates
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Enumeration Date | 03/27/2026
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Last Update Date | 03/27/2026
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Provider Practice Location Address
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Address Line | 1680 SW NEWLAND WAY STE 100
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City | LAKE CITY
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State | FL
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Zip | 32025-6917
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Country | US
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Telephone | 386-752-1342
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Fax |
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Provider Business Mailing Address
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Address Line | 414 SE HARDING ST
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City | MADISON
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State | FL
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Zip | 32340-4832
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | LIZZETT MUJICA
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Credential | DDS
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Telephone | 305-799-0654
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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 |
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License Number State |
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