Provider Demographics
NPI:1245641810
Name:LIZETTE BARZAGA DMD PA
Entity type:Organization
Organization Name:LIZETTE BARZAGA DMD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LIZETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARZAGA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:305-445-6006
Mailing Address - Street 1:147 ALHAMBRA CIR STE 201
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4530
Mailing Address - Country:US
Mailing Address - Phone:305-445-6006
Mailing Address - Fax:
Practice Address - Street 1:147 ALHAMBRA CIRCLE SUITE 201
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134
Practice Address - Country:US
Practice Address - Phone:305-445-6006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 18367122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty