MEDICARE: DR. LISANDRA YERO 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	26922	FL

General Provider Information

NPI Number	:	1902537061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISANDRA YERO DMD

Provider Business Mailing Address
First Line	:	335 NELSON AVE
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-6734
Country	:	US
Telephone Number	:	407-205-3368
Fax Number	:

Provider Business Practice Location Address
First Line	:	1913 N CLYDE MORRIS BLVD STE 130
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-5519
Country	:	US
Telephone Number	:	386-274-2021
Fax Number	:

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

Provider Enumeration Date	:	06/20/2022
Last Update Date	:	06/20/2022

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