MEDICARE: LIILIAN ROSA ROCA-GODINEZ 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	1223G0001X	General Practice Dentistry	DN12949	FL

General Provider Information

NPI Number	:	1639261563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LIILIAN ROSA ROCA-GODINEZ DDS

Provider Business Mailing Address
First Line	:	4999 W 8TH AVE
Second Line	:	STE # 1
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-821-7681
Fax Number	:	305-821-7682

Provider Business Practice Location Address
First Line	:	4999 W 8TH AVE
Second Line	:	STE # 1
City	:	HIALEAH
State	:	FL
Zip	:	33012-3409
Country	:	US
Telephone Number	:	305-821-7681
Fax Number	:	305-821-7682

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

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/08/2007

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