Provider Demographics
NPI:1003440512
Name:PEREZ GARCIA, LIEN (DMD)
Entity Type:Individual
Prefix:
First Name:LIEN
Middle Name:
Last Name:PEREZ GARCIA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:676 SE 8TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-5607
Mailing Address - Country:US
Mailing Address - Phone:305-490-1023
Mailing Address - Fax:
Practice Address - Street 1:2000 NW 87TH AVE STE 215
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33172-2657
Practice Address - Country:US
Practice Address - Phone:786-953-6550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26829261QM1300X, 122300000X, 1223G0001X
FLDRPM2123390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program