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NPI Code Detail

MEDICARE: MADISON DENTISTRY LLC

MEDICARE: MADISON DENTISTRY LLC
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
1122300000XDentist

General Provider Information

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

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Directions to “MADISON DENTISTRY LLC ” Practice Location

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