MEDICARE: LA FAMILY DENTISTRY CORP

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962173369
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LA FAMILY DENTISTRY CORP

Provider Business Mailing Address
First Line	:	4835 E 4TH AVE STE A
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4835 E 4TH AVE STE A
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-1814
Country	:	US
Telephone Number	:	786-254-7253
Fax Number	:

Authorized Official
Title or Position	:	GENERAL DENTIST
Name	:	DR. ARLET LOPEZ NEYRA
Credential	:	DMD
Telephone Number	:	786-254-7253

Provider Enumeration Date	:	09/24/2021
Last Update Date	:	09/24/2021

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Directions to “LA FAMILY DENTISTRY CORP ” Practice Location

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