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General NPI Number Information
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NPI Number | 1871071340
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Entity Type | Organization
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Legal Business Name | LIBERTY DENTAL PLAN OF FLORIDA, INC.
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Dates
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Enumeration Date | 08/06/2018
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Last Update Date | 12/02/2025
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Provider Practice Location Address
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Address Line | 3109 W DR MARTIN LUTHER KING JR BLVD STE 100
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City | TAMPA
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State | FL
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Zip | 33607-6219
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Country | US
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Telephone | 888-703-6999
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Fax |
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Provider Business Mailing Address
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Address Line | 1730 FLIGHT WAY STE 125
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City | TUSTIN
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State | CA
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Zip | 92782-1828
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Country | US
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Telephone | 888-703-6999
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE OFFICER
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Name | MARZENA FERCZ
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Credential |
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Telephone | 888-703-6999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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