Provider Demographics
NPI:1487036216
Name:GATA GARCIA, LISSET (DDS)
Entity Type:Individual
Prefix:
First Name:LISSET
Middle Name:
Last Name:GATA GARCIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9240 SW 72ND ST STE 115
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3262
Mailing Address - Country:US
Mailing Address - Phone:305-595-0557
Mailing Address - Fax:305-595-3667
Practice Address - Street 1:5510 SW 92ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165
Practice Address - Country:US
Practice Address - Phone:786-339-0466
Practice Address - Fax:786-339-0466
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-29
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist