=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477046969
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIDIA SUAREZ DDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/11/2018
-----------------------------------------------------
Last Update Date | 11/07/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1800 FOREST HILL BLVD STE A3-4
-----------------------------------------------------
City | WEST PALM BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-6094
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-249-6114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 550 CYPRESS XING
-----------------------------------------------------
City | WELLINGTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33414-6376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-904-6891
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. LIDIA SUAREZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 305-904-6891
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | DN20107
-----------------------------------------------------
License Number State |
-----------------------------------------------------