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General NPI Number Information
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NPI Number | 1891688719
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Entity Type | Individual
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Provider Name | LIRIS ESTEVEZ PENA D.M.D
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Gender | Female
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Dates
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Enumeration Date | 05/30/2025
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Last Update Date | 05/30/2025
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Provider Practice Location Address
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Address Line | 21202 OLEAN BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33952-6751
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Country | US
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Telephone | 941-269-1332
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Fax |
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Provider Business Mailing Address
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Address Line | 1155 NW 123RD PL APT 303
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City | MIAMI
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State | FL
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Zip | 33182-2402
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Country | US
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Telephone | 786-768-1557
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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 | DN30299
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License Number State | FL
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