Provider Demographics
NPI:1639261563
Name:ROCA-GODINEZ, LIILIAN ROSA (DDS)
Entity Type:Individual
Prefix:
First Name:LIILIAN
Middle Name:ROSA
Last Name:ROCA-GODINEZ
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 1:4999 W 8TH AVE
Mailing Address - Street 2:STE # 1
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-3409
Mailing Address - Country:US
Mailing Address - Phone:305-821-7681
Mailing Address - Fax:305-821-7682
Practice Address - Street 1:4999 W 8TH AVE
Practice Address - Street 2:STE # 1
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3409
Practice Address - Country:US
Practice Address - Phone:305-821-7681
Practice Address - Fax:305-821-7682
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN129491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice