MEDICARE: ESTRELLA DENTAL INSTITUTE 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
1	122300000X	Dentist

General Provider Information

NPI Number	:	1568315620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ESTRELLA DENTAL INSTITUTE LLC

Provider Business Mailing Address
First Line	:	4305 E 8TH AVE STE E
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2465
Country	:	US
Telephone Number	:	786-791-8573
Fax Number	:

Provider Business Practice Location Address
First Line	:	4305 E 8TH AVE STE E
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2465
Country	:	US
Telephone Number	:	786-791-8573
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	LISCARY FUERTES RUFIN
Credential	:	DDS
Telephone Number	:	786-791-8573

Provider Enumeration Date	:	02/18/2026
Last Update Date	:	02/18/2026

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