MEDICARE: LIVIA DE OLIVEIRA BARROS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	29292	FL

General Provider Information

NPI Number	:	1053157305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIVIA DE OLIVEIRA BARROS DDS

Provider Business Mailing Address
First Line	:	1652 REDSTONE CT
Second Line	:
City	:	ST AUGUSTINE
State	:	FL
Zip	:	32092-5028
Country	:	US
Telephone Number	:	585-957-0086
Fax Number	:

Provider Business Practice Location Address
First Line	:	5210 BELFORT RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-6024
Country	:	US
Telephone Number	:	585-957-0086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2024
Last Update Date	:	07/06/2024

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