Provider Demographics
NPI:1235374471
Name:LE BONA, DAISY (DMD)
Entity Type:Individual
Prefix:
First Name:DAISY
Middle Name:
Last Name:LE BONA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:DAISY
Other - Middle Name:
Other - Last Name:LE BONA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:550 SAN SERVANDO AVE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33143-6323
Mailing Address - Country:US
Mailing Address - Phone:954-557-0184
Mailing Address - Fax:
Practice Address - Street 1:2501 SW 22ND ST
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33145-3403
Practice Address - Country:US
Practice Address - Phone:954-557-0184
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-02
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN185081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry