MEDICARE: LISANDRA COMPANIONI DMD

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	DN25923	FL

General Provider Information

NPI Number	:	1790356376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISANDRA COMPANIONI DMD

Provider Business Mailing Address
First Line	:	2663 W 73RD PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33016-5425
Country	:	US
Telephone Number	:	786-488-5674
Fax Number	:

Provider Business Practice Location Address
First Line	:	2675 WINKLER AVE STE 150
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9328
Country	:	US
Telephone Number	:	239-204-2780
Fax Number	:

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

Provider Enumeration Date	:	07/06/2021
Last Update Date	:	07/06/2021

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Directions to “ LISANDRA COMPANIONI DMD” Practice Location

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