Provider Demographics
NPI:1245667757
Name:LIRIOS DENTAL CLINIC DDS, CORP
Entity type:Organization
Organization Name:LIRIOS DENTAL CLINIC DDS, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIBIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DENTIST
Authorized Official - Phone:305-477-7655
Mailing Address - Street 1:7902 NW 36TH ST
Mailing Address - Street 2:SUITE 209
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6637
Mailing Address - Country:US
Mailing Address - Phone:305-477-7655
Mailing Address - Fax:305-477-7654
Practice Address - Street 1:7902 NW 36TH ST
Practice Address - Street 2:SUITE 209
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6637
Practice Address - Country:US
Practice Address - Phone:305-477-7655
Practice Address - Fax:305-477-7654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-28
Last Update Date:2013-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN125291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty