MEDICARE: LIBIA R RIOS DDS PA

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

General Provider Information

NPI Number	:	1891140455
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIBIA R RIOS DDS PA

Provider Business Mailing Address
First Line	:	8901 SW 157TH AVE
Second Line	:	#12
City	:	MIAMI
State	:	FL
Zip	:	33196-1102
Country	:	US
Telephone Number	:	786-536-5754
Fax Number	:	786-409-5894

Provider Business Practice Location Address
First Line	:	8901 SW 157TH AVE
Second Line	:	#12
City	:	MIAMI
State	:	FL
Zip	:	33196-1102
Country	:	US
Telephone Number	:	786-536-5754
Fax Number	:	786-409-5894

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LIBIA R RIOS
Credential	:	DDS
Telephone Number	:	786-378-1906

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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