florida medicaid adult - liberty dental plan · member services / servicios para miembros : (833)...

54
Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA COUNTY DENTIST #RHC010936 Acorn Clinic 23320 N. State Rd, Ste 235 Brooker, FL 32622 (352) 485-2772 Gujarati, English, Spanish M-T 8am-4pm W-Th 8am-4pm # DN9374 Hsiung, Edwin NPI: 1417389586 LIC: DN9374 CERTIFICATIONS : #FQHC010440 Azalea Health 410 Ne Waldo Road Gainesville, FL 32641 (352) 375-3790 English, Spanish M-T 8am-5pm W-F 8am-5pm # DN21424 Budzinski, Volha NPI: 1588047468 LIC: DN21424 CERTIFICATIONS : # DN15770 Halady, Pratima NPI: 1720256811 LIC: DN15770 CERTIFICATIONS : # HAD56 Krotzinger, Mary NPI: 1992796973 LIC: HAD56 CERTIFICATIONS : # DN20873 Lopez, Melvin NPI: 1689081242 LIC: DN20873 CERTIFICATIONS : # DN12941 Pairot, Alfredo NPI: 1932174448 LIC: DN12941 CERTIFICATIONS : # DN8746 Saraga, David NPI: 1780805028 LIC: DN8746 CERTIFICATIONS : #010934 Edwin F. Johary, DDS 1831 Nw 13Th Street, Ste #4 Gainesville, FL 32609 (352) 377-0360 English, Spanish M-T 9am-5pm W-F 9am-5pm # DN15990 Johary, Edwin* NPI: 1609916899 LIC: DN15990 CERTIFICATIONS : • Inhalation Sedation #011246 Gainesville Dental Center 4000 West Newberry Road, Ste E Gainesville, FL 32607 (352) 378-3131 English, Arabic M-T 9am-5pm W 9am-5pm, # DN9531 Attia, Safwat* NPI: 1952311730 LIC: DN9531 CERTIFICATIONS : #010755 University of Florida College of Dentistry 1600 Sw Archer Road Gainesville, FL 32610 www.dental.ufl.edu (352) 273-6820 English, Other M-T 8am-5pm W-F 8am-5pm # DN14714 Barnes, David NPI: 1467667451 LIC: DN14714 CERTIFICATIONS : # DN7077 Benjamin, Paul NPI: 1225057128 LIC: DN7077 CERTIFICATIONS : # DTP675 Camargo, Carlos NPI: 1518459312 LIC: DTP675 CERTIFICATIONS : # DTP657 Cassiano, Luisa NPI: 1295281335 LIC: DTP657 CERTIFICATIONS : # DN8382 Cook, Larry NPI: 1902813777 LIC: DN8382 CERTIFICATIONS : # DTP630 Delgado Caraballo, Maria NPI: 1003274002 LIC: DTP630 CERTIFICATIONS : # DTP603 Delgado, Alejandro NPI: 1669887485 LIC: DTP603 CERTIFICATIONS : # DTP639 Dias Ribeiro, Ana NPI: 1053860924 LIC: DTP639 CERTIFICATIONS : # DN13471 Dilbone, Deborah NPI: 1104882497 LIC: DN13471 CERTIFICATIONS : # DN16318 Djuric, Amira NPI: 1033291471 LIC: DN16318 CERTIFICATIONS : # DN8807 Garvey, Timothy NPI: 1205892296 LIC: DN8807 CERTIFICATIONS : # DTP400 Gibbs, Micaela NPI: 1902862469 LIC: DTP400 CERTIFICATIONS : # DTP680 Guha, Upoma NPI: 1184153132 LIC: DTP680 CERTIFICATIONS : # DN7710 Haddix, James NPI: 1336105709 LIC: DN7710 CERTIFICATIONS : # DTP672 Haddock, Fernando NPI: 1477531234 LIC: DTP672 CERTIFICATIONS : # DTP679 Hansen, Matthew NPI: 1598008153 LIC: DTP679 CERTIFICATIONS : # DN9870 Kaleel, Nicholas NPI: 1447258991 LIC: DN9870 CERTIFICATIONS : # DTP604 Kashtwari, Deeba NPI: 1669880407 LIC: DTP604 CERTIFICATIONS : # DN21295 Luaces, Olga NPI: 1407237555 LIC: DN21295 CERTIFICATIONS : # DTP659 Migliorati, Cesar NPI: 1992810519 LIC: DTP659 CERTIFICATIONS : • Inhalation Sedation # DN8944 Ottenga, Marc NPI: 1306802293 LIC: DN8944 CERTIFICATIONS : • Inhalation Sedation # DTP612 Pereira, Patricia NPI: 1437535218 LIC: DTP612 CERTIFICATIONS : # DN14930 Rey, Rosalia NPI: 1346341443 LIC: DN14930 CERTIFICATIONS : # DTP490 Ribeiro-DaSilva, Margarete NPI: 1326228321 LIC: DTP490 CERTIFICATIONS : # DTP623 Ruprecht, Axel NPI: 1699763631 LIC: DTP623 CERTIFICATIONS : # DTP669 Sikand, Rebecca NPI: 1942654546 LIC: DTP669 CERTIFICATIONS : # DTP645 Silva, Maria NPI: 1932452547 LIC: DTP645 CERTIFICATIONS : # DTP458 Tomar, Scott NPI: 1487606950 LIC: DTP458 CERTIFICATIONS : ENDODONTICS # DTP654 Bakiri, Eleonora NPI: 1952834418 LIC: DTP654 CERTIFICATIONS : # DTP450 Pileggi, Roberta NPI: 1356393821 LIC: DTP450 CERTIFICATIONS : • Board Certification • Inhalation Sedation ORAL SURGEON # DN9991 Bowers, Thomas NPI: 1851340426 LIC: DN9991 CERTIFICATIONS : • General Anesthesia • Inhalation Sedation # DTP232 Dolwick, Melvin NPI: 1659337590 LIC: DTP232 CERTIFICATIONS : • Board Certification • Inhalation Sedation # DTP664 Freburg-Hoffmeister, Danielle NPI: 1447545132 LIC: DTP664 CERTIFICATIONS : • Inhalation Sedation # DN20097 Guevara, Carlo NPI: 1851602734 LIC: DN20097 CERTIFICATIONS : • Conscious Sedation • General Anesthesia • Inhalation Sedation • Intravenous Sedation LIBERTY Dental Plan network provider rating is based on quality measures and service. Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality. The provider directory is subject to change without notice. Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan. If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card. To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid. El directorio de proveedores está sujeto a cambios sin previo aviso. Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan. Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación. Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid. * Closed to new members / Cerrado para nuevos miembros. Page 1 of 54 February, 2020 02/10/2020 v.1(2018) Wheelchair access / Acceso para personas en silla de ruedas.

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Page 1: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

ALACHUA COUNTY

DENTIST

#RHC010936

Acorn Clinic

23320 N. State Rd, Ste 235

Brooker, FL 32622

(352) 485-2772

Gujarati, English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN9374 Hsiung, Edwin

NPI: 1417389586 LIC: DN9374

CERTIFICATIONS :

#FQHC010440

Azalea Health

410 Ne Waldo Road

Gainesville, FL 32641

(352) 375-3790

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21424 Budzinski, Volha

NPI: 1588047468 LIC: DN21424

CERTIFICATIONS :

# DN15770 Halady, Pratima

NPI: 1720256811 LIC: DN15770

CERTIFICATIONS :

# HAD56 Krotzinger, Mary

NPI: 1992796973 LIC: HAD56

CERTIFICATIONS :

# DN20873 Lopez, Melvin

NPI: 1689081242 LIC: DN20873

CERTIFICATIONS :

# DN12941 Pairot, Alfredo

NPI: 1932174448 LIC: DN12941

CERTIFICATIONS :

# DN8746 Saraga, David

NPI: 1780805028 LIC: DN8746

CERTIFICATIONS :

#010934

Edwin F. Johary, DDS

1831 Nw 13Th Street, Ste #4

Gainesville, FL 32609

(352) 377-0360

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15990 Johary, Edwin*

NPI: 1609916899 LIC: DN15990

CERTIFICATIONS :

• Inhalation Sedation

#011246

Gainesville Dental Center

4000 West Newberry Road, Ste E

Gainesville, FL 32607

(352) 378-3131

English, Arabic

M-T 9am-5pm

W 9am-5pm,

# DN9531 Attia, Safwat*

NPI: 1952311730 LIC: DN9531

CERTIFICATIONS :

#010755

University of Florida College of

Dentistry

1600 Sw Archer Road

Gainesville, FL 32610

www.dental.ufl.edu

(352) 273-6820

English, Other

M-T 8am-5pm

W-F 8am-5pm

# DN14714 Barnes, David

NPI: 1467667451 LIC: DN14714

CERTIFICATIONS :

# DN7077 Benjamin, Paul

NPI: 1225057128 LIC: DN7077

CERTIFICATIONS :

# DTP675 Camargo, Carlos

NPI: 1518459312 LIC: DTP675

CERTIFICATIONS :

# DTP657 Cassiano, Luisa

NPI: 1295281335 LIC: DTP657

CERTIFICATIONS :

# DN8382 Cook, Larry

NPI: 1902813777 LIC: DN8382

CERTIFICATIONS :

# DTP630 Delgado Caraballo, Maria

NPI: 1003274002 LIC: DTP630

CERTIFICATIONS :

# DTP603 Delgado, Alejandro

NPI: 1669887485 LIC: DTP603

CERTIFICATIONS :

# DTP639 Dias Ribeiro, Ana

NPI: 1053860924 LIC: DTP639

CERTIFICATIONS :

# DN13471 Dilbone, Deborah

NPI: 1104882497 LIC: DN13471

CERTIFICATIONS :

# DN16318 Djuric, Amira

NPI: 1033291471 LIC: DN16318

CERTIFICATIONS :

# DN8807 Garvey, Timothy

NPI: 1205892296 LIC: DN8807

CERTIFICATIONS :

# DTP400 Gibbs, Micaela

NPI: 1902862469 LIC: DTP400

CERTIFICATIONS :

# DTP680 Guha, Upoma

NPI: 1184153132 LIC: DTP680

CERTIFICATIONS :

# DN7710 Haddix, James

NPI: 1336105709 LIC: DN7710

CERTIFICATIONS :

# DTP672 Haddock, Fernando

NPI: 1477531234 LIC: DTP672

CERTIFICATIONS :

# DTP679 Hansen, Matthew

NPI: 1598008153 LIC: DTP679

CERTIFICATIONS :

# DN9870 Kaleel, Nicholas

NPI: 1447258991 LIC: DN9870

CERTIFICATIONS :

# DTP604 Kashtwari, Deeba

NPI: 1669880407 LIC: DTP604

CERTIFICATIONS :

# DN21295 Luaces, Olga

NPI: 1407237555 LIC: DN21295

CERTIFICATIONS :

# DTP659 Migliorati, Cesar

NPI: 1992810519 LIC: DTP659

CERTIFICATIONS :

• Inhalation Sedation

# DN8944 Ottenga, Marc

NPI: 1306802293 LIC: DN8944

CERTIFICATIONS :

• Inhalation Sedation

# DTP612 Pereira, Patricia

NPI: 1437535218 LIC: DTP612

CERTIFICATIONS :

# DN14930 Rey, Rosalia

NPI: 1346341443 LIC: DN14930

CERTIFICATIONS :

# DTP490 Ribeiro-DaSilva, Margarete

NPI: 1326228321 LIC: DTP490

CERTIFICATIONS :

# DTP623 Ruprecht, Axel

NPI: 1699763631 LIC: DTP623

CERTIFICATIONS :

# DTP669 Sikand, Rebecca

NPI: 1942654546 LIC: DTP669

CERTIFICATIONS :

# DTP645 Silva, Maria

NPI: 1932452547 LIC: DTP645

CERTIFICATIONS :

# DTP458 Tomar, Scott

NPI: 1487606950 LIC: DTP458

CERTIFICATIONS :

ENDODONTICS

# DTP654 Bakiri, Eleonora

NPI: 1952834418 LIC: DTP654

CERTIFICATIONS :

# DTP450 Pileggi, Roberta

NPI: 1356393821 LIC: DTP450

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

ORAL SURGEON

# DN9991 Bowers, Thomas

NPI: 1851340426 LIC: DN9991

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DTP232 Dolwick, Melvin

NPI: 1659337590 LIC: DTP232

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DTP664 Freburg-Hoffmeister,

Danielle

NPI: 1447545132 LIC: DTP664

CERTIFICATIONS :

• Inhalation Sedation

# DN20097 Guevara, Carlo

NPI: 1851602734 LIC: DN20097

CERTIFICATIONS :

• Conscious Sedation

• General Anesthesia

• Inhalation Sedation

• Intravenous Sedation

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 1 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 2: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Oral / Enteral Sedation

• Parenteral Sedation

• Pediatric Conscious Sedation

# DN19786 Hamrick, Clayton

NPI: 1548523665 LIC: DN19786

CERTIFICATIONS :

# DN12910 Hardeman, John

NPI: 1447343918 LIC: DN12910

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

PERIODONTICS

# DTP687 Duarte Reis, Poliana

NPI: 1619448677 LIC: DTP687

CERTIFICATIONS :

# DTP638 Duarte, Wagner

NPI: 1407305022 LIC: DTP638

CERTIFICATIONS :

# DTP537 Neiva, Rodrigo

NPI: 1457485229 LIC: DTP537

CERTIFICATIONS :

# DTP690 Tanaka, Tsuyoshi

NPI: 1407208853 LIC: DTP690

CERTIFICATIONS :

PROSTHODONTICS

# DTP390 Echeto, Luisa

NPI: 1144286386 LIC: DTP390

CERTIFICATIONS :

# DTP467 Esquivel-Upshaw,

Josephine

NPI: 1760495527 LIC: DTP467

CERTIFICATIONS :

# DTP439 O'Neill, Edgar

NPI: 1235195413 LIC: DTP439

CERTIFICATIONS :

BAKER COUNTY

DENTIST

#CHC013141

DOH - Baker County Health

Department

480 W. Lowder St

Macclenny, FL 32063

[email protected]

(904) 259-9815M-T 8am-5pm

W-Th 8am-5pm

# DN11888 Hackney, Tara

NPI: 1710953765 LIC: DN11888

CERTIFICATIONS :

• Inhalation Sedation

BAY COUNTY

DENTIST

#FQHC022012

PanCare of Florida

12427 Hwy 231

Youngstown, FL 32466

(850) 215-3575

English

M-T 8am-5pm

W-F 8am-5pm

# DN19128 Claussen, Meghann

NPI: 1336454651 LIC: DN19128

CERTIFICATIONS :

# DN13094 Hudon, Richard

NPI: 1245336031 LIC: DN13094

CERTIFICATIONS :

# DN22620 Knowles, Laura

NPI: 1346778412 LIC: DN22620

CERTIFICATIONS :

# DN23419 Lindsay, Sean

NPI: 1477046290 LIC: DN23419

CERTIFICATIONS :

# DN21740 Moffa, Michelle

NPI: 1841277407 LIC: DN21740

CERTIFICATIONS :

# DN19745 Norton, Andrew

NPI: 1861754020 LIC: DN19745

CERTIFICATIONS :

# HAD73 Pankuch, Richard

NPI: 1467452847 LIC: HAD73

CERTIFICATIONS :

# DN21660 Piorkowski, Gary

NPI: 1699705434 LIC: DN21660

CERTIFICATIONS :

# HAD69 Smith, Amy

NPI: 1831209899 LIC: HAD69

CERTIFICATIONS :

# DN18668 Van Dyke, Kanyaratana

NPI: 1003122656 LIC: DN18668

CERTIFICATIONS :

# HAD65 Wilhite, Rhonda

NPI: 1952496341 LIC: HAD65

CERTIFICATIONS :

#FQHC010683

PanCare of Florida, Inc.

403 E. 11Th St

Panama City, FL 32401

(850) 767-3350

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 5pm

# DN19128 Claussen, Meghann

NPI: 1336454651 LIC: DN19128

CERTIFICATIONS :

# DN13094 Hudon, Richard

NPI: 1245336031 LIC: DN13094

CERTIFICATIONS :

# DN22620 Knowles, Laura

NPI: 1346778412 LIC: DN22620

CERTIFICATIONS :

# DN23419 Lindsay, Sean

NPI: 1477046290 LIC: DN23419

CERTIFICATIONS :

# DN21740 Moffa, Michelle

NPI: 1841277407 LIC: DN21740

CERTIFICATIONS :

# DN19745 Norton, Andrew

NPI: 1861754020 LIC: DN19745

CERTIFICATIONS :

# HAD73 Pankuch, Richard

NPI: 1467452847 LIC: HAD73

CERTIFICATIONS :

# DN21660 Piorkowski, Gary

NPI: 1699705434 LIC: DN21660

CERTIFICATIONS :

# DN23084 Santos, Iris

NPI: 1487875233 LIC: DN23084

CERTIFICATIONS :

# HAD69 Smith, Amy

NPI: 1831209899 LIC: HAD69

CERTIFICATIONS :

# DN18668 Van Dyke, Kanyaratana

NPI: 1003122656 LIC: DN18668

CERTIFICATIONS :

# HAD65 Wilhite, Rhonda

NPI: 1952496341 LIC: HAD65

CERTIFICATIONS :

# DN22573 Williams, Sean

NPI: 1306376512 LIC: DN22573

CERTIFICATIONS :

ORAL SURGEON

#010672

Eric R. Claussen D.M.D., P.A.

2624 Jenks Ave

Panama City, FL 32405

(850) 215-0798

English

M-T 8am-5pm

W-F 8am-5pm

# DN17080 Claussen, Eric

NPI: 1194983965 LIC: DN17080

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN23806 Long, Larry

NPI: 1275527137 LIC: DN23806

CERTIFICATIONS :

BREVARD COUNTY

DENTIST

#FQHC011681

Brevard Health Alliance

2120 Sarno Rd

Melbourne, FL 32935

(321) 241-6800

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# HAD82 Alongi, Jennifer

NPI: 1306139019 LIC: HAD82

CERTIFICATIONS :

• Inhalation Sedation

# DN14021 Cheshire, Gregory

NPI: 1952303059 LIC: DN14021

CERTIFICATIONS :

• Inhalation Sedation

# DN21925 Eley, Joel

NPI: 1326491093 LIC: DN21925

CERTIFICATIONS :

• Inhalation Sedation

# DN9369 Estes, Philip

NPI: 1255766937 LIC: DN9369

CERTIFICATIONS :

• Inhalation Sedation

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 2 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 3: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN13760 Hachmeister, Kevin

NPI: 1811922966 LIC: DN13760

CERTIFICATIONS :

# HAD16 Kormann, Jacqueline

NPI: 1346214889 LIC: HAD16

CERTIFICATIONS :

# DN20658 Smith, Ross

NPI: 1245626811 LIC: DN20658

CERTIFICATIONS :

• Inhalation Sedation

#011378

Diane P Jones, DMD, PA

4670 Lipscomb Street Ne, Ste 13

Palm Bay, FL 32905

(321) 724-1343

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN10077 Jones, Diane*

NPI: 1699893651 LIC: DN10077

CERTIFICATIONS :

#CHC015259

DOH - Brevard County Health

Department

2555 Judge Fran Jamieson Way

Viera, FL 32940

(321) 639-5801

English, Spanish

M-T 8am-5pm

W 8am-5pm,

# DN9634 Humphrey, Willie

NPI: 1225190184 LIC: DN9634

CERTIFICATIONS :

# DN17682 Klair, Kelly

NPI: 1205033222 LIC: DN17682

CERTIFICATIONS :

# DN21014 Nagaraju, Champaka

NPI: 1659769891 LIC: DN21014

CERTIFICATIONS :

# DN11385 Traul Jr., Robert

NPI: 1982734257 LIC: DN11385

CERTIFICATIONS :

#CHC015260

DOH - Brevard County Health

Department

611 N. Singleton Ave

Titusville, FL 32796

(321) 637-7300

English, Spanish

W-Th 8am-5pm

# DN9634 Humphrey, Willie

NPI: 1225190184 LIC: DN9634

CERTIFICATIONS :

# DN17682 Klair, Kelly

NPI: 1205033222 LIC: DN17682

CERTIFICATIONS :

# DN21014 Nagaraju, Champaka

NPI: 1659769891 LIC: DN21014

CERTIFICATIONS :

# DN11385 Traul Jr., Robert

NPI: 1982734257 LIC: DN11385

CERTIFICATIONS :

#022718

Quality Dentures, LLC

313 N. Babcock Street

Melbourne, FL 32935

(321) 259-1949

English

T 8am - 4pm

W-Th 8am-4pm

# DN10444 Bell, E. Scott

NPI: 1093725558 LIC: DN10444

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#CHC015259

DOH - Brevard County Health

Department

2555 Judge Fran Jamieson Way

Viera, FL 32940

(321) 639-5801

English, Spanish

M-T 8am-5pm

W 8am-5pm,

# HAD31 Cunnion, Dara

NPI: 1427128727 LIC: HAD31

CERTIFICATIONS :

• Board Certification

#CHC015260

DOH - Brevard County Health

Department

611 N. Singleton Ave

Titusville, FL 32796

(321) 637-7300

English, Spanish

W-Th 8am-5pm

# HAD31 Cunnion, Dara

NPI: 1427128727 LIC: HAD31

CERTIFICATIONS :

• Board Certification

BROWARD COUNTY

DENTIST

#008934

Ahmad Ahmadi D.M.D., PA

12311 Taft Street Ste 2

Pembroke Pines, FL 33026

www.pearlywhitesmiles.fl.com

(954) 430-5700

English, Spanish, Persian

T 8am - 2pm

S 8am - 2pm

# DN16261 Ahmadi, Ahmad

NPI: 1538275292 LIC: DN16261

CERTIFICATIONS :

#008935

Ahmad Ahmadi D.M.D., PA

6656 Parkside Drive

Parkland, FL 33067

www.pearlywhitesmiles.fl.com

(954) 752-8283

English, Spanish, Persian

M 8am - 2pm,

W 8am-2pm,

S 8am - 2pm

# DN16261 Ahmadi, Ahmad

NPI: 1538275292 LIC: DN16261

CERTIFICATIONS :

#013157

All Care Dental

3207 North State Road 7, Ste 24

Margate, FL 33063

(954) 979-1357

English, Spanish, Portuguese

M 10am - 3pm, T 9am - 5pm

W 9am-5pm, Th 9am-7pm,F

10am-12pm

# DN16620 Yeoshoua, Oded

NPI: 1396969507 LIC: DN16620

CERTIFICATIONS :

#022277

Allure Dental of Plantation PLLC

1945 N Pine Island Road

Fort Lauderdale, FL 33322

(954) 473-9161

English, Russian, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN20696 Kopynets, Viktor

NPI: 1932517042 LIC: DN20696

CERTIFICATIONS :

• Inhalation Sedation

# DN12167 Kuntsmann, Vivian

NPI: 1104995539 LIC: DN12167

CERTIFICATIONS :

# DN24073 Martinez, Lester

NPI: 1689235624 LIC: DN24073

CERTIFICATIONS :

# DN17761 Valdman, Vadim

NPI: 1184860413 LIC: DN17761

CERTIFICATIONS :

• Inhalation Sedation

#016880

Allure Dental PLLC

4267 W. Commerical Blvd

Tamarac, FL 33319

(954) 677-3202

English, Russian, French, Spanish

M-T 9am-5pm

Th-F 9am-5pm

S 9am - 3pm

# DN24073 Martinez, Lester

NPI: 1689235624 LIC: DN24073

CERTIFICATIONS :

# DN17761 Valdman, Vadim

NPI: 1184860413 LIC: DN17761

CERTIFICATIONS :

• Inhalation Sedation

#016082

Angelic Smiles Dental Spa

9990 Nw 6Th Court

Hollywood, FL 33024

www.angelicsmilesdentalspa.com

(954) 237-3902

English, Spanish

M 9am - 6pm,

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 3 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 4: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Th-F 9am-4pm

S 9am - 2pm

# DN19661 Williams, Tosha

NPI: 1609009463 LIC: DN19661

CERTIFICATIONS :

• Inhalation Sedation

#010213

Bella Family Dental, Inc.

19551 Sheridan Street

Pembroke Pines, FL 33332

www.mybellafamilydental,com

(954) 621-7959

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN19939 Ruiz Frontany, Yarimar

NPI: 1134429251 LIC: DN19939

CERTIFICATIONS :

• Inhalation Sedation

#020606

Bright Smiles of Sunrise

10108 W Oakland Park Blvd.

Sunrise, FL 33351

(954) 900-2059

English, Spanish

M 10am - 7pm, T 9am - 5pm

W 9am-5pm, Th 9am-6pm,F 9am-5pm

# DN21846 Fonseca, Jacqueline

NPI: 1487005369 LIC: DN21846

CERTIFICATIONS :

#FQHC020446

Broward Community & Family

Health Centers, Inc

162 N. Powerline Rd.

Pompano Beach, FL 33069

(954) 970-7067

English, Spanish, Creoles and Pidgins

(other), French

M 8am - 5pm, T 10am - 7pm

W-F 8am-5pm

S 8am - 1pm

# DN23003 Aldorri, Khalid

NPI: 1396261277 LIC: DN23003

CERTIFICATIONS :

# DN24341 Salas, Julio

NPI: 1427619253 LIC: DN24341

CERTIFICATIONS :

# DN22291 Taylor, Shelly

NPI: 1508224155 LIC: DN22291

CERTIFICATIONS :

#012454

Broward Family Dental Care

6260 W. Oakland Park Blvd

Sunrise, FL 33313

(954) 742-7995

English, Farsi, Spanish

M-T 9am-4pm

W-Th 9am-4pm

S 9am - 7pm

# DN14848 Fadavi, Sayed

NPI: 1245247097 LIC: DN14848

CERTIFICATIONS :

#006578

Broward Mall Dental

8000 W. Broward Blvd, Ste 1123

Plantation, FL 33388

(954) 476-0802

Russian, Spanish

M-T 10am-9pm

W-F 10am-9pm

S-Su 10am-6pm

# DN22246 Antezana, Mauricio

NPI: 1063876399 LIC: DN22246

CERTIFICATIONS :

# DN7894 Cullen, William

NPI: 1013110535 LIC: DN7894

CERTIFICATIONS :

• Inhalation Sedation

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN22796 Gandhi, Poorvi

NPI: 1548631229 LIC: DN22796

CERTIFICATIONS :

# DN20710 Gonzalez, Kely

NPI: 1952717027 LIC: DN20710

CERTIFICATIONS :

# DN10511 Green, George

NPI: 1609094580 LIC: DN10511

CERTIFICATIONS :

# DN22451 Gruenberg, Alex

NPI: 1255844924 LIC: DN22451

CERTIFICATIONS :

# DN22242 Guerra, Vannette

NPI: 1598184327 LIC: DN22242

CERTIFICATIONS :

# DN23847 Khan, Adiba

NPI: 1649638172 LIC: DN23847

CERTIFICATIONS :

# DN24131 Krupnov, Vera

NPI: 1386202984 LIC: DN24131

CERTIFICATIONS :

# DN20101 Licina, Zeljka

NPI: 1013263292 LIC: DN20101

CERTIFICATIONS :

# DN23637 Lopez, Catherine

NPI: 1558841890 LIC: DN23637

CERTIFICATIONS :

# DN22702 Pham, Quynhnhu

NPI: 1609323948 LIC: DN22702

CERTIFICATIONS :

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

# DN23021 Riboul, Sandrine

NPI: 1609227057 LIC: DN23021

CERTIFICATIONS :

• Inhalation Sedation

# DN23007 Rivera, Lina

NPI: 1760908743 LIC: DN23007

CERTIFICATIONS :

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

# DN20475 Santiago, Germaine

NPI: 1922341460 LIC: DN20475

CERTIFICATIONS :

# DN23257 Shippee, Rebecca

NPI: 1841778164 LIC: DN23257

CERTIFICATIONS :

#FQHC014907

Community AIDS Resource, Inc.

871 W. Oakland Park Blvd

Fort Lauderdale, FL 33311

(954) 567-7141

English, Spanish, Creoles and Pidgins,

French-based(other)

M-T 8am-5pm

Th-F 8am-5pm

# DN13731 Barnes, Curtis

NPI: 1689798936 LIC: DN13731

CERTIFICATIONS :

# DN18139 Casas, Manuel

NPI: 1740420090 LIC: DN18139

CERTIFICATIONS :

# DN20973 Martinez, Amy

NPI: 1124382866 LIC: DN20973

CERTIFICATIONS :

# DN20674 Sardinas, Yoan

NPI: 1992118657 LIC: DN20674

CERTIFICATIONS :

#009929

Coral Springs Family Dentistry

6267 West Sample Road

Coral Springs, FL 33067

www.familydentistryofsouthflorida.com

(954) 341-4766

English, Spanish, Portuguese

M-T 10am-7pm

W-F 10am-7pm

# DN14972 Stein, Ilya

NPI: 1235260407 LIC: DN14972

CERTIFICATIONS :

#013315

David Eugene, DDS, PLLC

2447 North State Road 7

Fort Lauderdale, FL 33313

(954) 733-9971

French, English, Creoles and Pidgins,

French-based(other)

M-T 9am-5pm

W 9am-5pm, Th 9am-6pm,F 9am-1pm

S 9am - 1pm

# DN18594 Eugene, David

NPI: 1306080304 LIC: DN18594

CERTIFICATIONS :

#019656

Dental Excellence Partners

680 N. University Drive

Pembroke Pines, FL 33024

(954) 982-7645

English, Spanish

M-T 8am-6pm

W-F 8am-6pm

# DN20182 Aponte-Barrios, Secil

NPI: 1164714176 LIC: DN20182

CERTIFICATIONS :

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 4 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 5: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#020092

Dental Excellence Partners, LLC

4358 N Federal Hwy

Fort Lauderdale, FL 33308

(954) 776-3320

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#015845

Diaz Dental Group

2879 S. University Dr

Davie, FL 33328

(954) 474-2422

English, Spanish, French

M-T 10am-5pm

W 10am-7pm, Th 10am-5pm

# DN20123 Diaz, Yanet

NPI: 1215376934 LIC: DN20123

CERTIFICATIONS :

#007988

Exclusive Dental Care Group, Inc.

1724 N. University Dr

Pembroke Pines, FL 33024

(954) 432-8000

Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN13937 Figueroa, Celia

NPI: 1497962658 LIC: DN13937

CERTIFICATIONS :

#020227

Family Dental Associates PA

6130 West Atlantic Blvd

Margate, FL 33063

(954) 973-0990

English, Spanish, Creoles and Pidgins

(other)

M-T 8am-5pm

W-Th 8am-5pm

# DN17643 Blackmore, Sofia

NPI: 1427387687 LIC: DN17643

CERTIFICATIONS :

# DN10097 Lewis, Brad

NPI: 1376567685 LIC: DN10097

CERTIFICATIONS :

# DN19201 Mingel, Marc

NPI: 1831402957 LIC: DN19201

CERTIFICATIONS :

# DN13900 Polasky, Steven

NPI: 1366583312 LIC: DN13900

CERTIFICATIONS :

#010038

Family Dental Care

1600 N. State Rd 7, Ste 400

Lauderhill, FL 33313

(954) 581-9228

Portuguese, English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 1pm

# DN18305 Akel, Bassil

NPI: 1700040557 LIC: DN18305

CERTIFICATIONS :

#008950

Family Smile Dental

701 Promenade Drive Ste 102

Pembroke Pines, FL 33026

(954) 272-9250

English, Spanish

M 12pm - 7pm, T 9am - 5pm

W-Th 9am-5pm

# DN17384 Mujtaba, Moneeze

NPI: 1609926310 LIC: DN17384

CERTIFICATIONS :

#013821

Gateway Dental Inc

6720 Pines Blvd.

Pembroke Pines, FL 33024

(305) 856-2300

Spanish, English

M-T 9am-5pm

W-Th 9am-5pm

# DN18302 Herrera, Victoria

NPI: 1114185550 LIC: DN18302

CERTIFICATIONS :

# DN15212 Miranda, Pablo

NPI: 1023036365 LIC: DN15212

CERTIFICATIONS :

# DN15477 Perrotti, Steven

NPI: 1144249780 LIC: DN15477

CERTIFICATIONS :

# DN21226 Santana, David

NPI: 1700266657 LIC: DN21226

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

#022831

Gentle Teeth and Braces of

Weston

2751 Executive Park Drive

Fort Lauderdale, FL 33331

(954) 217-0288

English, Spanish

M-T 8am-8pm

W-Th 8am-8pm

# DN22685 Perez-Borroto Rodrigez,

Daylis

NPI: 1790215309 LIC: DN22685

CERTIFICATIONS :

#017850

Great Smiles Dental of Fort

Lauderdale

2633 E. Commercial Blvd Ste B

Fort Lauderdale, FL 33308

(954) 530-5352

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 1pm

# DN19482 Murcia, Marcela

NPI: 1588952261 LIC: DN19482

CERTIFICATIONS :

#013365

Lakes Mall Dental Center, PA

11401 Pines Blvd, Ste 220

Pembroke Pines, FL 33026

(954) 432-5515

English, Spanish

T 10am - 4pm

W 12pm-7pm, Th 10am-4pm,F

12pm-7pm

S 9am - 3pm

# DN19377 Calderon, Erik

NPI: 1942596416 LIC: DN19377

CERTIFICATIONS :

• Inhalation Sedation

# DN22454 Dominguez, Ivelisse

NPI: 1386098655 LIC: DN22454

CERTIFICATIONS :

#017607

Mercy Dental Group

3172 S. University Dr

Hollywood, FL 33025

(954) 404-6877

English, Spanish

M 10am - 6pm, T 9am - 5pm

W 9am-5pm, Th 10am-6pm,F

9am-2pm

# DN21842 Alvarado, Yailen

NPI: 1700235363 LIC: DN21842

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 5 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 6: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN21847 Diaz, Jany

NPI: 1659729598 LIC: DN21847

CERTIFICATIONS :

#010345

NSU- BGMC Oral & Maxillofacial

Surgery

1600 S. Andrews Ave, 3Rd Floor

Fort Lauderdale, FL 33316

(954) 355-5703

English, Spanish

M 1pm - 5pm,

W-F 9am-5pm

# DN13419 Ede-Nichols, Diane

NPI: 1225145683 LIC: DN13419

CERTIFICATIONS :

# DN22197 Khatib, Adel

NPI: 1235582503 LIC: DN22197

CERTIFICATIONS :

# DN20908 Mutawalli, Khalid

NPI: 1750754818 LIC: DN20908

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010341

NSU- JDCH Center for

Cranio-Facial Pediatric & Dental

Care

3501 Johnson Street, Ste 200

Hollywood, FL 33021

(954) 262-2187

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13419 Ede-Nichols, Diane

NPI: 1225145683 LIC: DN13419

CERTIFICATIONS :

# DN22197 Khatib, Adel

NPI: 1235582503 LIC: DN22197

CERTIFICATIONS :

# DN20908 Mutawalli, Khalid

NPI: 1750754818 LIC: DN20908

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#010346

NSU- Pediatric Dental Care

Center @ Kids

819 Ne 26Th St, Ste C

Wilton Manors, FL 33305

(954) 262-1751

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN20908 Mutawalli, Khalid

NPI: 1750754818 LIC: DN20908

CERTIFICATIONS :

• Inhalation Sedation

• Pediatric Conscious Sedation

#018790

Oral 1 Dental Group

7153 N Pine Island Rd

Fort Lauderdale, FL 33321

(954) 532-3247

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN20878 Londono, Laura

NPI: 1679982839 LIC: DN20878

CERTIFICATIONS :

#017867

Pembroke Miro Dental Office

7071 Taft Street

Hollywood, FL 33024

(954) 436-7699

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21293 Merikas, Amanda

NPI: 1669853305 LIC: DN21293

CERTIFICATIONS :

# DN11650 Miro, Claudio

NPI: 1417024118 LIC: DN11650

CERTIFICATIONS :

• Conscious Sedation

#019516

Perfect Smile Dental Spa

117 S. 21St Ave

Hollywood, FL 33020

(954) 364-7626

English, Spanish

M-T 9am-5pm

W 10am-5pm, Th 12pm-6pm

# DN15823 Galbut, Kimberly

NPI: 1649580747 LIC: DN15823

CERTIFICATIONS :

# DN17884 Lyons, James

NPI: 1851341853 LIC: DN17884

CERTIFICATIONS :

#017093

Preferred Dental Care, PA

2263 S. University Drive

Davie, FL 33324

(954) 475-0700

English, Russian, Spanish

M 8am - 5pm, T 12pm - 6pm

W-F 8am-5pm

S 9am - 3pm

# DN20696 Kopynets, Viktor

NPI: 1932517042 LIC: DN20696

CERTIFICATIONS :

• Inhalation Sedation

# DN24073 Martinez, Lester

NPI: 1689235624 LIC: DN24073

CERTIFICATIONS :

# DN17761 Valdman, Vadim

NPI: 1184860413 LIC: DN17761

CERTIFICATIONS :

• Inhalation Sedation

#006581

Sawgrass Mills Mall Dental

12801 W. Sunrise Blvd, Ste F222

Sunrise, FL 33323

(954) 846-7171

Russian, Spanish, Creoles and

Pidgins, French-based(other)

M-T 10am-9pm

W-F 10am-9pm

S 10am - 6pm

# DN7894 Cullen, William

NPI: 1013110535 LIC: DN7894

CERTIFICATIONS :

• Inhalation Sedation

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN22796 Gandhi, Poorvi

NPI: 1548631229 LIC: DN22796

CERTIFICATIONS :

# DN22451 Gruenberg, Alex

NPI: 1255844924 LIC: DN22451

CERTIFICATIONS :

# DN22242 Guerra, Vannette

NPI: 1598184327 LIC: DN22242

CERTIFICATIONS :

# DN23847 Khan, Adiba

NPI: 1649638172 LIC: DN23847

CERTIFICATIONS :

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

# DN12167 Kuntsmann, Vivian

NPI: 1104995539 LIC: DN12167

CERTIFICATIONS :

# DN23637 Lopez, Catherine

NPI: 1558841890 LIC: DN23637

CERTIFICATIONS :

# DN15694 Luong, Timothy

NPI: 1740302629 LIC: DN15694

CERTIFICATIONS :

# DN19470 Maniglia, Marielba

NPI: 1063793644 LIC: DN19470

CERTIFICATIONS :

# DN23402 Montenegro, Christian

NPI: 1144714445 LIC: DN23402

CERTIFICATIONS :

# DN23454 Nguyen, Michelle

NPI: 1033603733 LIC: DN23454

CERTIFICATIONS :

• Inhalation Sedation

# DN22702 Pham, Quynhnhu

NPI: 1609323948 LIC: DN22702

CERTIFICATIONS :

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

# DN23021 Riboul, Sandrine

NPI: 1609227057 LIC: DN23021

CERTIFICATIONS :

• Inhalation Sedation

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

# DN20475 Santiago, Germaine

NPI: 1922341460 LIC: DN20475

CERTIFICATIONS :

# DN18770 Trujillo, Madelene

NPI: 1881835767 LIC: DN18770

CERTIFICATIONS :

# DN21066 Uzunova-Dimova, Kalina

NPI: 1245540947 LIC: DN21066

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 6 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 7: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#016127

Shalom Sunset Dental Care

6491 Sunset Strip, Ste 1

Sunrise, FL 33313

(954) 572-1801

English, Spanish

M 9am - 6pm,

W-Th 9am-6pm

# DN20938 Castello Polo, Blanca

NPI: 1710380316 LIC: DN20938

CERTIFICATIONS :

#015404

Smile At Margate

5404 W. Atlantic Blvd

Pompano Beach, FL 33063

smileatmargate.com

(954) 974-4400

English, Arabic, Farsi, Persian,

Spanish, Turkish

M 9am - 5pm, T 9am - 7pm

W 9am-5pm, Th 9am-7pm

S 9am - 3pm

# DN19381 Shayan, Maria

NPI: 1700172673 LIC: DN19381

CERTIFICATIONS :

#010564

Smile Solutions Dental Group

294 Nw 172Nd Ave

Hollywood, FL 33029

(954) 432-3655

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 1pm

# DN19465 De Sousa, Marvina

NPI: 1841572963 LIC: DN19465

CERTIFICATIONS :

# DN19470 Maniglia, Marielba

NPI: 1063793644 LIC: DN19470

CERTIFICATIONS :

#014644

Smiles Dental PLLC

700 W. Hillsboro Blvd, Ste 1-109,

Bldg 1

Deerfield Beach, FL 33441

(754) 264-7264

English, Spanish, Creoles and Pidgins,

English-based(other), French, Hindi,

Telugu

M-T 9am-5pm

W-F 9am-5pm

S 9am - 4pm

# DN15925 Atluri, Suneetha

NPI: 1063525731 LIC: DN15925

CERTIFICATIONS :

• Inhalation Sedation

#016630

Soto & Castillo Dental Care Inc

3911 Hollywood Blvd, Ste 102

Hollywood, FL 33021

(954) 987-3344

English, Spanish, Portuguese

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN20757 Castillo, Sandra

NPI: 1245636133 LIC: DN20757

CERTIFICATIONS :

# DN20370 Soto, Paola

NPI: 1336572007 LIC: DN20370

CERTIFICATIONS :

#015901

Stephen Rothenberg DDS

416 E. Hallandale Beach Blvd.

Hallandale, FL 33009

(954) 457-8288

Romanian, English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN7410 Rothenberg, Stephen

NPI: 1083802052 LIC: DN7410

CERTIFICATIONS :

#008257

Tin Wai Hui, DMD, PA

17901 Nw 5Th Street, Ste #206

Pembroke Pines, FL 33029

(954) 430-2188

English, Arabic, Cantonese, Chinese

Mandarin, Russian, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 2pm

# DN15966 Elperin, Alexei

NPI: 1295930063 LIC: DN15966

CERTIFICATIONS :

# DN23439 Fraga, Salome

NPI: 1205322856 LIC: DN23439

CERTIFICATIONS :

# DN12723 Hui, Tin

NPI: 1952408619 LIC: DN12723

CERTIFICATIONS :

# DN15867 Shather, Meriam

NPI: 1790973873 LIC: DN15867

CERTIFICATIONS :

ENDODONTICS

#010341

NSU- JDCH Center for

Cranio-Facial Pediatric & Dental

Care

3501 Johnson Street, Ste 200

Hollywood, FL 33021

(954) 262-2187

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN9429 Flax, Michael

NPI: 1164583985 LIC: DN9429

CERTIFICATIONS :

# DN18606 Manjarres, Vivian

NPI: 1073747333 LIC: DN18606

CERTIFICATIONS :

# DN17496 Seltzer, Robert

NPI: 1619082120 LIC: DN17496

CERTIFICATIONS :

# DN14230 Zeim, Jason

NPI: 1760498422 LIC: DN14230

CERTIFICATIONS :

#010346

NSU- Pediatric Dental Care

Center @ Kids

819 Ne 26Th St, Ste C

Wilton Manors, FL 33305

(954) 262-1751

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN9429 Flax, Michael

NPI: 1164583985 LIC: DN9429

CERTIFICATIONS :

# DTP629 Griffin, Ina

NPI: 1609941178 LIC: DTP629

CERTIFICATIONS :

# DN18606 Manjarres, Vivian

NPI: 1073747333 LIC: DN18606

CERTIFICATIONS :

# DN17496 Seltzer, Robert

NPI: 1619082120 LIC: DN17496

CERTIFICATIONS :

# DN14230 Zeim, Jason

NPI: 1760498422 LIC: DN14230

CERTIFICATIONS :

ORAL SURGEON

#010345

NSU- BGMC Oral & Maxillofacial

Surgery

1600 S. Andrews Ave, 3Rd Floor

Fort Lauderdale, FL 33316

(954) 355-5703

English, Spanish

M 1pm - 5pm,

W-F 9am-5pm

# DTP482 McClure, Shawn

NPI: 1649313925 LIC: DTP482

CERTIFICATIONS :

• Board Certification

ORTHODONTIST

#010346

NSU- Pediatric Dental Care

Center @ Kids

819 Ne 26Th St, Ste C

Wilton Manors, FL 33305

(954) 262-1751

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DTP600 Contasti-Bocco, Gisela

NPI: 1871903914 LIC: DTP600

CERTIFICATIONS :

# DN16470 Vargas, Jorge

NPI: 1154419349 LIC: DN16470

CERTIFICATIONS :

#022347

Shaun L. Smith DDS PLLC

8223 W. Atlantic Blvd

Pompano Beach, FL 33071

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 7 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 8: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(954) 368-0105

English, Spanish

M 10am - 6pm, T 9am - 5pm

W 10am-6pm, Th 9am-5pm

# DN23095 Smith, Shaun

NPI: 1932499217 LIC: DN23095

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#010345

NSU- BGMC Oral & Maxillofacial

Surgery

1600 S. Andrews Ave, 3Rd Floor

Fort Lauderdale, FL 33316

(954) 355-5703

English, Spanish

M 1pm - 5pm,

W-F 9am-5pm

# DN17762 Ocanto, Romer

NPI: 1124133426 LIC: DN17762

CERTIFICATIONS :

• Inhalation Sedation

# DN17441 Oramas, Victor

NPI: 1235217571 LIC: DN17441

CERTIFICATIONS :

• Board Certification

#010341

NSU- JDCH Center for

Cranio-Facial Pediatric & Dental

Care

3501 Johnson Street, Ste 200

Hollywood, FL 33021

(954) 262-2187

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN4823 Arnold Jr., Dan

NPI: 1275644668 LIC: DN4823

CERTIFICATIONS :

• Inhalation Sedation

# DTP643 Chin, Judith

NPI: 1124151592 LIC: DTP643

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DTP648 Kim, Margaret

NPI: 1649292103 LIC: DTP648

CERTIFICATIONS :

• Inhalation Sedation

# DTP259 Larumbe, Jose

NPI: 1972605038 LIC: DTP259

CERTIFICATIONS :

• Inhalation Sedation

# DTP526 Noguera, Alberto

NPI: 1619206752 LIC: DTP526

CERTIFICATIONS :

• Inhalation Sedation

# DN17762 Ocanto, Romer

NPI: 1124133426 LIC: DN17762

CERTIFICATIONS :

• Inhalation Sedation

# DN17441 Oramas, Victor

NPI: 1235217571 LIC: DN17441

CERTIFICATIONS :

• Board Certification

# DTP557 Padilla, Oscar

NPI: 1669478863 LIC: DTP557

CERTIFICATIONS :

• Inhalation Sedation

#010342

NSU- Mailman Segal Institute -

Dental

7600 Sw 36Th Street, Bldg.100,

Room 1263

Davie, FL 33328

(954) 262-7127

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17762 Ocanto, Romer

NPI: 1124133426 LIC: DN17762

CERTIFICATIONS :

• Inhalation Sedation

#010346

NSU- Pediatric Dental Care

Center @ Kids

819 Ne 26Th St, Ste C

Wilton Manors, FL 33305

(954) 262-1751

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN4823 Arnold Jr., Dan

NPI: 1275644668 LIC: DN4823

CERTIFICATIONS :

• Inhalation Sedation

# DTP643 Chin, Judith

NPI: 1124151592 LIC: DTP643

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DTP648 Kim, Margaret

NPI: 1649292103 LIC: DTP648

CERTIFICATIONS :

• Inhalation Sedation

# DTP259 Larumbe, Jose

NPI: 1972605038 LIC: DTP259

CERTIFICATIONS :

• Inhalation Sedation

# DTP526 Noguera, Alberto

NPI: 1619206752 LIC: DTP526

CERTIFICATIONS :

• Inhalation Sedation

# DN17762 Ocanto, Romer

NPI: 1124133426 LIC: DN17762

CERTIFICATIONS :

• Inhalation Sedation

# DN17441 Oramas, Victor

NPI: 1235217571 LIC: DN17441

CERTIFICATIONS :

• Board Certification

# DTP557 Padilla, Oscar

NPI: 1669478863 LIC: DTP557

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

#006581

Sawgrass Mills Mall Dental

12801 W. Sunrise Blvd, Ste F222

Sunrise, FL 33323

(954) 846-7171

Russian, Spanish, Creoles and

Pidgins, French-based(other)

M-T 10am-9pm

W-F 10am-9pm

S 10am - 6pm

# DN13591 Nielsen, Pamela

NPI: 1124118245 LIC: DN13591

CERTIFICATIONS :

CALHOUN COUNTY

DENTIST

#013160

Myron D. Schrock, DMD, PA

17470 North Main Street

Blountstown, FL 32424

www.myronshrockdmd.com

(850) 237-1400

English

M-T 8am-5pm

W-Th 8am-5pm

# DN13527 Schrock, Myron

NPI: 1730245846 LIC: DN13527

CERTIFICATIONS :

CHARLOTTE COUNTY

DENTIST

#CHC011905

DOH - Charlotte County Health

Department

1100 Loveland Blvd

Port Charlotte, FL 33980

(941) 624-7200

English

M-T 8am-5pm

W-F 8am-5pm

# HAD100 Miles, Kenneth

NPI: 1063563724 LIC: HAD100

CERTIFICATIONS :

CITRUS COUNTY

DENTIST

#FQHC016660

Langley Health Services

314 S. Line Ave

Inverness, FL 34452

(352) 419-4056

English

M-T 8am-5pm

W-F 8am-5pm

# DN23356 Lutes, Meaghan

NPI: 1760974554 LIC: DN23356

CERTIFICATIONS :

# DN17030 Sykes, Daniel

NPI: 1528273703 LIC: DN17030

CERTIFICATIONS :

# DN13460 Tutay, John

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 8 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 9: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1043413180 LIC: DN13460

CERTIFICATIONS :

CLAY COUNTY

DENTIST

#008723

Walnut Street Dental Center

407 Walnut Street

Green Cove Springs, FL 32043

(904) 284-0773

Sign Languages

M-T 9am-5pm

Th-F 9am-5pm

# DN7301 McCabe, John

NPI: 1588734149 LIC: DN7301

CERTIFICATIONS :

ORAL SURGEON

#018291

Imray & Gesek DMD PA

1409 Kingsley Ave Ste 5

Orange Park, FL 32073

(904) 264-7383

English

M 8am - 5pm,

F 7am-2pm

# DN13575 Gesek, Daniel

NPI: 1831129774 LIC: DN13575

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN10533 Imray, Scott

NPI: 1740362367 LIC: DN10533

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

COLLIER COUNTY

DENTIST

#CHC015257

DOH - Collier County Health

Department

3339 East Tamiami Trail, Ste 145

Naples, FL 34106

(239) 252-5314

English, Spanish, Italian, Romanian

M-T 7am-4pm

W 7am-5pm, Th 7am-4pm,F 7am-5pm

# DN19780 Danu, Dana

NPI: 1174887327 LIC: DN19780

CERTIFICATIONS :

#FQHC013671

Healthcare Network of SW FL

1454 Madison Ave

Immokalee, FL 34142

(239) 658-3000

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21878 Mancera-Loftin, Julie

NPI: 1033569447 LIC: DN21878

CERTIFICATIONS :

• Inhalation Sedation

# DN22155 Ochoa, Margarita

NPI: 1376785329 LIC: DN22155

CERTIFICATIONS :

• Inhalation Sedation

# DN23447 Patalinghug, Lady

Joedeline

NPI: 1700232535 LIC: DN23447

CERTIFICATIONS :

# DN23310 Patalinghug, Ulysses

NPI: 1689020935 LIC: DN23310

CERTIFICATIONS :

# DN23771 Riggio, Anthony

NPI: 1043716996 LIC: DN23771

CERTIFICATIONS :

#FQHC013672

Healthcare Network of SW FL

1749 Heritage Trail Ste # 801

Naples, FL 34112

(239) 658-3000

English, Old (ca.450-1100), Spanish

M-T 8am-5pm

W-F 8am-5pm

# HAD90 Ellsworth, Kathleen

NPI: 1174526651 LIC: HAD90

CERTIFICATIONS :

# DN14099 Ferrer, Norma

NPI: 1518139989 LIC: DN14099

CERTIFICATIONS :

• Inhalation Sedation

# DN20893 Larios, Filadelfo

NPI: 1932508355 LIC: DN20893

CERTIFICATIONS :

• Inhalation Sedation

# DN18068 Le, Jade

NPI: 1154541845 LIC: DN18068

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

# DN23771 Riggio, Anthony

NPI: 1043716996 LIC: DN23771

CERTIFICATIONS :

#FQHC014580

Healthcare Network of SW FL

4077 Tamiami Trail N

Naples, FL 34103

(239) 658-3000

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# HAD90 Ellsworth, Kathleen

NPI: 1174526651 LIC: HAD90

CERTIFICATIONS :

# DN19676 Gross, Eitan

NPI: 1326474768 LIC: DN19676

CERTIFICATIONS :

• General Anesthesia

# DN22155 Ochoa, Margarita

NPI: 1376785329 LIC: DN22155

CERTIFICATIONS :

• Inhalation Sedation

# DN23447 Patalinghug, Lady

Joedeline

NPI: 1700232535 LIC: DN23447

CERTIFICATIONS :

# DN23310 Patalinghug, Ulysses

NPI: 1689020935 LIC: DN23310

CERTIFICATIONS :

# DN23771 Riggio, Anthony

NPI: 1043716996 LIC: DN23771

CERTIFICATIONS :

#FQHC022371

Healthcare Network of SW FL

2355 Stanford Ct, Ste 701

Naples, FL 34112

(239) 658-3000

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

# HAD90 Ellsworth, Kathleen

NPI: 1174526651 LIC: HAD90

CERTIFICATIONS :

# DN19676 Gross, Eitan

NPI: 1326474768 LIC: DN19676

CERTIFICATIONS :

• General Anesthesia

# DN20893 Larios, Filadelfo

NPI: 1932508355 LIC: DN20893

CERTIFICATIONS :

• Inhalation Sedation

# DN18068 Le, Jade

NPI: 1154541845 LIC: DN18068

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

# DN21878 Mancera-Loftin, Julie

NPI: 1033569447 LIC: DN21878

CERTIFICATIONS :

• Inhalation Sedation

# DN22155 Ochoa, Margarita

NPI: 1376785329 LIC: DN22155

CERTIFICATIONS :

• Inhalation Sedation

# DN19289 Orr, Elizabeth

NPI: 1346234853 LIC: DN19289

CERTIFICATIONS :

• Inhalation Sedation

# DN23447 Patalinghug, Lady

Joedeline

NPI: 1700232535 LIC: DN23447

CERTIFICATIONS :

#014619

Northern Dental General and

Cosmetic Dentistry LLC

5651 Naples Blvd

Naples, FL 34109

(239) 431-5666

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN20711 Novak, Shannon

NPI: 1871904581 LIC: DN20711

CERTIFICATIONS :

#017214

Polo Dental of Naples

4280 Tamiami Trail East, Ste 201

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 9 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 10: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Naples, FL 34112

(239) 258-0421

English, Spanish, French

M 10am - 6pm, T 9am - 6pm

W 9am-7pm, Th 9am-6pm

# DN23454 Nguyen, Michelle

NPI: 1033603733 LIC: DN23454

CERTIFICATIONS :

• Inhalation Sedation

#022815

Wisdom Dental PA

5064 Annunciation Circle, Ste 101

Ave Maria, FL 34142

(239) 919-6930

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21551 Akpaka, Wisdom

NPI: 1114338738 LIC: DN21551

CERTIFICATIONS :

PEDIATRIC DENTISTRY

#FQHC014580

Healthcare Network of SW FL

4077 Tamiami Trail N

Naples, FL 34103

(239) 658-3000

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17804 Gedeon, Rose

NPI: 1063547545 LIC: DN17804

CERTIFICATIONS :

• Inhalation Sedation

COLUMBIA COUNTY

DENTIST

#FQHC012459

Palms Dentistry

173 Nw Albritton Lane

Lake City, FL 32055

(386) 752-5904

English

M-T 8am-5pm

W-F 8am-5pm

# DN9869 Jones, Stanley

NPI: 1528162047 LIC: DN9869

CERTIFICATIONS :

# DN20927 Rooney, Matthew

NPI: 1598165532 LIC: DN20927

CERTIFICATIONS :

• Inhalation Sedation

DE SOTO COUNTY

DENTIST

#CHC10198

DOH - DeSoto County Health

Department

34 S. Baldwin Ave

Arcadia, FL 34266

(863) 993-4601

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# HAD53 Morris, Thomas

NPI: 1548396385 LIC: HAD53

CERTIFICATIONS :

# DN18285 Snyder, Kirk

NPI: 1295996767 LIC: DN18285

CERTIFICATIONS :

DIXIE COUNTY

DENTIST

#011247

Family Cosmetic Dentistry

91 Se Highway 349

Old Town, FL 32680

(352) 542-7400

English

# DN9531 Attia, Safwat*

NPI: 1952311730 LIC: DN9531

CERTIFICATIONS :

DUVAL COUNTY

DENTIST

#009170

1 Day Denture

1329 Lane Ave South, Ste 1

Jacksonville, FL 32205

www.1daydenturejax.com

(904) 683-0415

English, Spanish

T 8am - 4pm

W-F 8am-4pm

# DN3300 Chamberlain, Norman

NPI: 1912155631 LIC: DN3300

CERTIFICATIONS :

• Inhalation Sedation

#008933

A Better Smile Denture Center

7645 Merrill Road Ste 305

Jacksonville, FL 32277

(904) 493-1005

English, Spanish, Gujarati, Hindi

M-T 8am-4pm

W-Th 8am-4pm

# DN8397 Morrison, Wendell

NPI: 1114104775 LIC: DN8397

CERTIFICATIONS :

# DN15848 Mumford-Clarke,

Kymberli

NPI: 1316965742 LIC: DN15848

CERTIFICATIONS :

• Inhalation Sedation

# G132973 Vann, Joslyn

NPI: 1902984222 LIC: G132973

CERTIFICATIONS :

• Inhalation Sedation

#FQHC020800

Beaches Community Health

Dental Clinic

850 6Th Ave South Ste #500

Jacksonville Beach, FL 32250

(904) 394-5471

English, Spanish

W 8am-4pm,

# DN20641 Makary, Sara

NPI: 1851704654 LIC: DN20641

CERTIFICATIONS :

# DN20613 Martin, Shakela

NPI: 1639582943 LIC: DN20613

CERTIFICATIONS :

#010665

Dental Place of Jax, P.A.

5800 Beach Blvd, Ste 102

Jacksonville, FL 32207

(904) 330-0630

English, Spanish

M-T 8am-4pm

# DN17326 Bunch, Nicole

NPI: 1891824934 LIC: DN17326

CERTIFICATIONS :

#021571

Dentures & More - Coastal Dental

Services

4402 Old Sailsbury Road

Jacksonville, FL 32216

(904) 296-7757

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN6329 Davis, Robert

NPI: 1962613901 LIC: DN6329

CERTIFICATIONS :

#010314

KNJ Dental, P.A.

9861-1 Beach Blvd

Jacksonville, FL 32246

(904) 565-1800

English, Spanish

M-T 7am-5pm

W 7am-5pm, Th 7am-3pm

# DN22156 Van, Tim

NPI: 1881047132 LIC: DN22156

CERTIFICATIONS :

# DN12568 Vera, Kevin

NPI: 1780607770 LIC: DN12568

CERTIFICATIONS :

#009752

Regency Square Mall Dental P.A.

9501 Arlington Express Way Ste

0345

Jacksonville, FL 32225

(904) 727-6055

Russian, Arabic, English, Spanish

M-T 10am-7pm

W-F 10am-7pm

S 10am - 7pm

# DN22246 Antezana, Mauricio

NPI: 1063876399 LIC: DN22246

CERTIFICATIONS :

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 10 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 11: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN7894 Cullen, William

NPI: 1013110535 LIC: DN7894

CERTIFICATIONS :

• Inhalation Sedation

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN22796 Gandhi, Poorvi

NPI: 1548631229 LIC: DN22796

CERTIFICATIONS :

# DN22451 Gruenberg, Alex

NPI: 1255844924 LIC: DN22451

CERTIFICATIONS :

# DN22242 Guerra, Vannette

NPI: 1598184327 LIC: DN22242

CERTIFICATIONS :

# DN22389 Inaba, Caroline

NPI: 1629319249 LIC: DN22389

CERTIFICATIONS :

# DN23847 Khan, Adiba

NPI: 1649638172 LIC: DN23847

CERTIFICATIONS :

# DN23637 Lopez, Catherine

NPI: 1558841890 LIC: DN23637

CERTIFICATIONS :

# DN22702 Pham, Quynhnhu

NPI: 1609323948 LIC: DN22702

CERTIFICATIONS :

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

# DN23021 Riboul, Sandrine

NPI: 1609227057 LIC: DN23021

CERTIFICATIONS :

• Inhalation Sedation

# DN23007 Rivera, Lina

NPI: 1760908743 LIC: DN23007

CERTIFICATIONS :

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

# DN20475 Santiago, Germaine

NPI: 1922341460 LIC: DN20475

CERTIFICATIONS :

ORAL SURGEON

#018290

Imray & Gesek DMD PA

2047 Park St

Jacksonville, FL 32204

(904) 264-7383

English

M-T 8am-5pm

W-Th 8am-5pm

# DN13575 Gesek, Daniel

NPI: 1831129774 LIC: DN13575

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN10533 Imray, Scott

NPI: 1740362367 LIC: DN10533

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

#009752

Regency Square Mall Dental P.A.

9501 Arlington Express Way Ste

0345

Jacksonville, FL 32225

(904) 727-6055

Russian, Arabic, English, Spanish

M-T 10am-7pm

W-F 10am-7pm

S 10am - 7pm

# DN21773 Hines, Jerri

NPI: 1861552770 LIC: DN21773

CERTIFICATIONS :

• General Anesthesia

ESCAMBIA COUNTY

DENTIST

#013222

Cordova Dental Center

5120 Bayou Blvd, Ste #4

Pensacola, FL 32503

(850) 477-3188

English, Farsi, Vietnamese

M-T 9am-5pm

W-F 9am-5pm

# DN11910 Schildroth, Charles

NPI: 1740334655 LIC: DN11910

CERTIFICATIONS :

#FQHC014964

ECC At Cantonment Pediatrics

470 S. Hwy 29

Cantonment, FL 32533

(850) 780-0111

English, Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN8846 Copenhaver, Lawrence

NPI: 1366409807 LIC: DN8846

CERTIFICATIONS :

# DN20201 Lane, Victoria

NPI: 1295179745 LIC: DN20201

CERTIFICATIONS :

# DN18871 Pate, Sheena

NPI: 1215255880 LIC: DN18871

CERTIFICATIONS :

# DN22386 Watkins, Jacinta

NPI: 1770885436 LIC: DN22386

CERTIFICATIONS :

#FQHC014990

ECC at Century Pediatrics

501 Church Street

Century, FL 32535

healthcarewithinreach.org

(850) 724-4054

English, Spanish

T 8am - 4pm

# DN8846 Copenhaver, Lawrence

NPI: 1366409807 LIC: DN8846

CERTIFICATIONS :

# DN18871 Pate, Sheena

NPI: 1215255880 LIC: DN18871

CERTIFICATIONS :

# DN22386 Watkins, Jacinta

NPI: 1770885436 LIC: DN22386

CERTIFICATIONS :

#FQHC022628

ECC at Century Primary Care

6021 Industrial Blvd

Century, FL 32535

(850) 724-4064

English

M-T 8am-4pm

W-F 8am-4pm

# DN8846 Copenhaver, Lawrence

NPI: 1366409807 LIC: DN8846

CERTIFICATIONS :

# DN23413 Digby, Gregory

NPI: 1437646080 LIC: DN23413

CERTIFICATIONS :

# DN19082 Hernandez, Gabriel

NPI: 1093956088 LIC: DN19082

CERTIFICATIONS :

# DN18871 Pate, Sheena

NPI: 1215255880 LIC: DN18871

CERTIFICATIONS :

# DN22386 Watkins, Jacinta

NPI: 1770885436 LIC: DN22386

CERTIFICATIONS :

#FQHC013509

ECC Dental Clinic

1295 W. Fairfield Dr

Pensacola, FL 32501

(850) 912-8880

English

M-T 7am-4pm

W-F 7am-4pm

# DN8846 Copenhaver, Lawrence

NPI: 1366409807 LIC: DN8846

CERTIFICATIONS :

# DN19082 Hernandez, Gabriel

NPI: 1093956088 LIC: DN19082

CERTIFICATIONS :

# DN20201 Lane, Victoria

NPI: 1295179745 LIC: DN20201

CERTIFICATIONS :

# DN18871 Pate, Sheena

NPI: 1215255880 LIC: DN18871

CERTIFICATIONS :

# DN22386 Watkins, Jacinta

NPI: 1770885436 LIC: DN22386

CERTIFICATIONS :

#FQHC016760

Escambia Community Clinics Inc

14 W. Jordan St

Pensacola, FL 32501

(850) 436-4630

English, Spanish, Vietnamese

M-T 8am-4pm

W-F 8am-4pm

# DN8846 Copenhaver, Lawrence

NPI: 1366409807 LIC: DN8846

CERTIFICATIONS :

# DN20201 Lane, Victoria

NPI: 1295179745 LIC: DN20201

CERTIFICATIONS :

# DN18871 Pate, Sheena

NPI: 1215255880 LIC: DN18871

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 11 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 12: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN22386 Watkins, Jacinta

NPI: 1770885436 LIC: DN22386

CERTIFICATIONS :

FLAGLER COUNTY

DENTIST

#CHC10022

DOH - Flagler County Health

Department

301 Dr Carter Bvd

Bunnell, FL 32110

(386) 437-7350

English, Russian, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN16666 Bey, Frances

NPI: 1760458798 LIC: DN16666

CERTIFICATIONS :

# DN12581 Ramirez, Benigno

NPI: 1043230295 LIC: DN12581

CERTIFICATIONS :

#010967

Mark L Johnson, DDS, PA

215 South Third Street

Flagler Beach, FL 32136

(386) 439-9688

English

M-T 8am-4pm

W-Th 8am-4pm

# DN15035 Johnson, Mark

NPI: 1154443513 LIC: DN15035

CERTIFICATIONS :

FRANKLIN COUNTY

DENTIST

#FQHC015406

PanCare of Florida

106 Ne 5Th St

Carrabelle, FL 32322

(850) 215-3578

English

M-T 8am-5pm

W-F 8am-5pm

# DN19128 Claussen, Meghann

NPI: 1336454651 LIC: DN19128

CERTIFICATIONS :

# DN13094 Hudon, Richard

NPI: 1245336031 LIC: DN13094

CERTIFICATIONS :

# DN22620 Knowles, Laura

NPI: 1346778412 LIC: DN22620

CERTIFICATIONS :

# DN23419 Lindsay, Sean

NPI: 1477046290 LIC: DN23419

CERTIFICATIONS :

# DN21740 Moffa, Michelle

NPI: 1841277407 LIC: DN21740

CERTIFICATIONS :

# DN19745 Norton, Andrew

NPI: 1861754020 LIC: DN19745

CERTIFICATIONS :

# HAD73 Pankuch, Richard

NPI: 1467452847 LIC: HAD73

CERTIFICATIONS :

# DN21660 Piorkowski, Gary

NPI: 1699705434 LIC: DN21660

CERTIFICATIONS :

# HAD69 Smith, Amy

NPI: 1831209899 LIC: HAD69

CERTIFICATIONS :

# HAD65 Wilhite, Rhonda

NPI: 1952496341 LIC: HAD65

CERTIFICATIONS :

GADSDEN COUNTY

DENTIST

#014905

Dental Workz of Quincy

314 E. Jefferson St

Quincy, FL 32351

(850) 618-0114

English, Spanish

M-T 9am-6pm

W 12pm-6pm, Th 9am-6pm,F

9am-2pm

S 9am - 2pm

# DN21408 Howard, Enrique

NPI: 1639540446 LIC: DN21408

CERTIFICATIONS :

#FQHC015507

Jessie Furlow Medical Center

1249 Strong Rd

Quincy, FL 32351

www.northfloridamedicalcenters.org

(850) 875-9502

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN11230 Cherkinsky, Jordan

NPI: 1184637787 LIC: DN11230

CERTIFICATIONS :

# DN24185 Durham, Dominique

NPI: 1053972257 LIC: DN24185

CERTIFICATIONS :

#FQHC011429

Neighborhood Medical Center

604 E. 5Th Ave

Havana, FL 32333

(850) 539-8222

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-6pm

W-F 8am-6pm

# DN15616 Abreu, Romelio

NPI: 1568639268 LIC: DN15616

CERTIFICATIONS :

# DN22475 Butler, Latoya

NPI: 1003357351 LIC: DN22475

CERTIFICATIONS :

# DN19383 Garraway, Chinara

NPI: 1629364153 LIC: DN19383

CERTIFICATIONS :

# HAD84 Hall, Shai

NPI: 1013043637 LIC: HAD84

CERTIFICATIONS :

# DN20236 Laing, Christopher

NPI: 1356696272 LIC: DN20236

CERTIFICATIONS :

# DN18939 Thiry, Warren

NPI: 1477871697 LIC: DN18939

CERTIFICATIONS :

GILCHRIST COUNTY

DENTIST

#FQHC012458

Palms Medical Group

911 South Main St

Trenton, FL 32693

www.palmsmg.org

(352) 463-4526

English

M-T 8am-5pm

W-F 8am-5pm

# DN9869 Jones, Stanley

NPI: 1528162047 LIC: DN9869

CERTIFICATIONS :

# DN22911 Koubek, Catherine

NPI: 1730619594 LIC: DN22911

CERTIFICATIONS :

• Inhalation Sedation

# DN20927 Rooney, Matthew

NPI: 1598165532 LIC: DN20927

CERTIFICATIONS :

• Inhalation Sedation

GLADES COUNTY

DENTIST

#FQHC011249

Florida Community Health

Centers, Inc.

1021 Health Park Drive

Moore Haven, FL 33471

(863) 946-0405

English, Spanish, Creoles and Pidgins,

French-based(other), French

M-T 8am-5pm

W 8am-6pm, Th 8am-5pm,F 8am-4pm

# DN20720 Blackwood, Alberto

NPI: 1487057303 LIC: DN20720

CERTIFICATIONS :

# DN13607 Morales, Carlos

NPI: 1457310559 LIC: DN13607

CERTIFICATIONS :

# DN14000 Naryshkin, George

NPI: 1730395773 LIC: DN14000

CERTIFICATIONS :

# DN13771 Sanchez, Armando

NPI: 1992764930 LIC: DN13771

CERTIFICATIONS :

GULF COUNTY

DENTIST

#FQHC014254

PanCare of Florida

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 12 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 13: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

2475 Garrison Ave

Port Saint Joe, FL 32456

(850) 215-3578

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13094 Hudon, Richard

NPI: 1245336031 LIC: DN13094

CERTIFICATIONS :

# DN22620 Knowles, Laura

NPI: 1346778412 LIC: DN22620

CERTIFICATIONS :

# DN23419 Lindsay, Sean

NPI: 1477046290 LIC: DN23419

CERTIFICATIONS :

# DN21740 Moffa, Michelle

NPI: 1841277407 LIC: DN21740

CERTIFICATIONS :

# DN19745 Norton, Andrew

NPI: 1861754020 LIC: DN19745

CERTIFICATIONS :

# HAD73 Pankuch, Richard

NPI: 1467452847 LIC: HAD73

CERTIFICATIONS :

# DN21660 Piorkowski, Gary

NPI: 1699705434 LIC: DN21660

CERTIFICATIONS :

# HAD69 Smith, Amy

NPI: 1831209899 LIC: HAD69

CERTIFICATIONS :

# HAD65 Wilhite, Rhonda

NPI: 1952496341 LIC: HAD65

CERTIFICATIONS :

#FQHC014285

PanCare of Florida

807 W. Hwy 22

Wewahitchka, FL 32465

PANCAREFL.ORG

(850) 215-3578

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19128 Claussen, Meghann

NPI: 1336454651 LIC: DN19128

CERTIFICATIONS :

# DN13094 Hudon, Richard

NPI: 1245336031 LIC: DN13094

CERTIFICATIONS :

# DN22620 Knowles, Laura

NPI: 1346778412 LIC: DN22620

CERTIFICATIONS :

# DN23419 Lindsay, Sean

NPI: 1477046290 LIC: DN23419

CERTIFICATIONS :

# DN21740 Moffa, Michelle

NPI: 1841277407 LIC: DN21740

CERTIFICATIONS :

# DN19745 Norton, Andrew

NPI: 1861754020 LIC: DN19745

CERTIFICATIONS :

# HAD73 Pankuch, Richard

NPI: 1467452847 LIC: HAD73

CERTIFICATIONS :

# DN21660 Piorkowski, Gary

NPI: 1699705434 LIC: DN21660

CERTIFICATIONS :

# HAD69 Smith, Amy

NPI: 1831209899 LIC: HAD69

CERTIFICATIONS :

# HAD65 Wilhite, Rhonda

NPI: 1952496341 LIC: HAD65

CERTIFICATIONS :

HARDEE COUNTY

DENTIST

#FQHC010736

Central Florida Health Care Inc

121 Kd Revell Rd

Wauchula, FL 33873

(863) 767-0696

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 7am-5pm

W-F 7am-5pm

# DN12871 Cardenas, Carlos

NPI: 1568649804 LIC: DN12871

CERTIFICATIONS :

# HAD92 Coello, Marla

NPI: 1891833620 LIC: HAD92

CERTIFICATIONS :

# DN13255 Cooper, Angela

NPI: 1912994914 LIC: DN13255

CERTIFICATIONS :

# DN18203 Geller, Robert

NPI: 1669503280 LIC: DN18203

CERTIFICATIONS :

# DN16346 Gomara, Denise

NPI: 1497887863 LIC: DN16346

CERTIFICATIONS :

# DN18154 Mckenzie, Karen

NPI: 1821286287 LIC: DN18154

CERTIFICATIONS :

# HAD33 Modaff, Michelle

NPI: 1497768295 LIC: HAD33

CERTIFICATIONS :

# DN6990 Seifert, Thomas

NPI: 1255654232 LIC: DN6990

CERTIFICATIONS :

# DN17405 Ward, Tasha

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

HENDRY COUNTY

DENTIST

#FQHC011248

Florida Community Health

Centers, Inc.

315 S. W C Owen Ave

Clewiston, FL 33440

(863) 983-7813

English, Spanish

M 8am - 5pm, T 8am - 6pm

W-Th 8am-5pm

# DN20720 Blackwood, Alberto

NPI: 1487057303 LIC: DN20720

CERTIFICATIONS :

# DN14000 Naryshkin, George

NPI: 1730395773 LIC: DN14000

CERTIFICATIONS :

# DN13771 Sanchez, Armando

NPI: 1992764930 LIC: DN13771

CERTIFICATIONS :

HERNANDO COUNTY

DENTIST

#FQHC016313

Premier Community HealthCare

Group, Inc.

300 S. Main St

Brooksville, FL 34601

(352) 518-2000

English, Spanish

T 7am - 4pm

# DN11556 Baker, Wayne

NPI: 1699833947 LIC: DN11556

CERTIFICATIONS :

# DN14806 Barinas-Duval, Froilan

NPI: 1699748442 LIC: DN14806

CERTIFICATIONS :

• Inhalation Sedation

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

#FQHC016314

Premier Community HealthCare

Group, Inc.

7551 Forest Oaks Blvd

Spring Hill, FL 34606

(352) 518-2000

English, Spanish

M 7am - 7pm, T 7am - 4pm

W-F 7am-4pm

# DN11556 Baker, Wayne

NPI: 1699833947 LIC: DN11556

CERTIFICATIONS :

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

HIGHLANDS COUNTY

DENTIST

#CHC7920

Central Florida Health Care

950 County Road 17-A West

Avon Park, FL 33825

(863) 452-3050

Spanish, English, Creoles and Pidgins,

English-based(other), French

M-T 7am-5pm

W-F 7am-5pm

# DN12871 Cardenas, Carlos

NPI: 1568649804 LIC: DN12871

CERTIFICATIONS :

# DN13255 Cooper, Angela

NPI: 1912994914 LIC: DN13255

CERTIFICATIONS :

# DN16346 Gomara, Denise

NPI: 1497887863 LIC: DN16346

CERTIFICATIONS :

# DN22245 Rubin, Joslyn

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 13 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 14: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1861940850 LIC: DN22245

CERTIFICATIONS :

HILLSBOROUGH COUNTY

DENTIST

#022643

Brandon Family Dental Care, LLC

227 N Knights Ave

Brandon, FL 33510

(813) 685-5611

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN11501 Parker, David

NPI: 1235255845 LIC: DN11501

CERTIFICATIONS :

#011547

Brandon Mall Dental PA

675 Brandon Town Center Mall

Brandon, FL 33511

(813) 681-8600

English, Russian, Spanish

T 10am - 4pm

W 10am-5pm, Th 10am-6pm,F

11am-6pm

S 9am - 5pm, Su 10am - 5pm

# DN17412 Atkinson, William

NPI: 1942360862 LIC: DN17412

CERTIFICATIONS :

• Inhalation Sedation

# DN22018 Pansuriya, Dharmendra

NPI: 1932645736 LIC: DN22018

CERTIFICATIONS :

#018497

Cordica Dental Designs

520 Oakfield Dr

Brandon, FL 33511

(813) 661-1800

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15530 Perez Diaz, Elizabeth

NPI: 1336242296 LIC: DN15530

CERTIFICATIONS :

• Inhalation Sedation

#007914

Deborah Austin-Brown DDS PA

420 N. Alexander St

Plant City, FL 33563

(813) 752-5520

English, Spanish

T 8am - 4pm

W-Th 8am-4pm

S 8am - 12pm

# DN11764 Austin, Deborah

NPI: 1295884765 LIC: DN11764

CERTIFICATIONS :

#019660

Dental Excellence Partners, LLC

4144 N. Armenia Ave. #150

Tampa, FL 33607

(813) 575-1635

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

#022656

Dental Excellence Partners, LLC

807 S. Parson Ave

Brandon, FL 33511

(813) 527-0245M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

#011013

Great Expressions Dental Centers

825 W. Martin Luther King Blvd

Tampa, FL 33603

(813) 237-1982

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19709 Biandudi, Odessa

NPI: 1679835599 LIC: DN19709

CERTIFICATIONS :

• Inhalation Sedation

# DN12680 Dos Passos II, John

NPI: 1265411953 LIC: DN12680

CERTIFICATIONS :

• Inhalation Sedation

# DN17010 Howell, Dina

NPI: 1326090200 LIC: DN17010

CERTIFICATIONS :

# DN19638 Immadi, Lakshmi

NPI: 1083988901 LIC: DN19638

CERTIFICATIONS :

# DN15142 Reed, Samantha

NPI: 1104042456 LIC: DN15142

CERTIFICATIONS :

• Inhalation Sedation

#010534

Guillermo Porro, D.M.D., P.A.

7059 West Waters Ave

Tampa, FL 33634

(813) 889-8599

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN10372 Porro, Guillermo*

NPI: 1346309689 LIC: DN10372

CERTIFICATIONS :

#018023

Happy Family Dental Group, Inc

510 Westbrook Ave

Brandon, FL 33511

(813) 651-0165

Creoles and Pidgins,

English-based(other), English,

Spanish

M-T 9am-4pm

W-Th 9am-4pm

# DN18899 Botero, Catalina

NPI: 1659513380 LIC: DN18899

CERTIFICATIONS :

• Inhalation Sedation

# DN23694 Yglesias Ruiz, Erick

NPI: 1427534239 LIC: DN23694

CERTIFICATIONS :

• Inhalation Sedation

#011149

Keystone Dental Excellence

8325 Gunn Hwy

Tampa, FL 33626

(813) 792-0041

English, Spanish

M-T 7am-4pm

W-Th 7am-4pm

# DN15969 Reinhart, Joel

NPI: 1033208392 LIC: DN15969

CERTIFICATIONS :

• Inhalation Sedation

#FQHC010979

Palm River Community Health

Center

7728 Palm River Rd

Tampa, FL 33619

(813) 630-3635

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15132 Dietz, Rodney

NPI: 1629326277 LIC: DN15132

CERTIFICATIONS :

#FQHC010829

Ruskin Health Center

2814 14Th Ave Se

Ruskin, FL 33570

(813) 653-6100

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20318 Cisneros, Aura

NPI: 1356346340 LIC: DN20318

CERTIFICATIONS :

• Inhalation Sedation

# DN16317 Dinh, Lan

NPI: 1568769008 LIC: DN16317

CERTIFICATIONS :

#014571

Sergio M. Lopez, DDS PLLC

3102 W. Waters Ave, Ste 101

Tampa, FL 33614

(813) 374-2441

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN18229 Lopez, Sergio

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 14 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 15: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1265441125 LIC: DN18229

CERTIFICATIONS :

#FQHC010830

Suncoast Mobile Dental Van

2814 14Th Ave Se

Ruskin, FL 33570

(813) 653-6100

English

M-T 8am-5pm

W-F 8am-5pm

# DN20318 Cisneros, Aura

NPI: 1356346340 LIC: DN20318

CERTIFICATIONS :

• Inhalation Sedation

# DN10403 Valdez, Harvey

NPI: 1548325491 LIC: DN10403

CERTIFICATIONS :

#FQHC010697

Tampa Family Health Centers

5611 Sheldon Rd

Tampa, FL 33615

(813) 397-5300

English, Spanish, French (T)

M-T 8am-5pm

W-F 8am-5pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN20612 Jean, Darlene

NPI: 1528474822 LIC: DN20612

CERTIFICATIONS :

# DN17431 Leon, Ana

NPI: 1578762332 LIC: DN17431

CERTIFICATIONS :

• Inhalation Sedation

# DN23805 Najafi, Gina

NPI: 1699259291 LIC: DN23805

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

#FQHC022679

Tampa Family Health Centers, Inc

12085 W. Hillsborough Ave

Tampa, FL 33635

(813) 866-0930

English

M-T 8am-5pm

W-F 8am-5pm

# DN23246 Boodhoo, Amanda

NPI: 1639531460 LIC: DN23246

CERTIFICATIONS :

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN23345 Ivanov, Simona

NPI: 1861987752 LIC: DN23345

CERTIFICATIONS :

# DN24211 Jacas, Jose

NPI: 1669032603 LIC: DN24211

CERTIFICATIONS :

# DN20612 Jean, Darlene

NPI: 1528474822 LIC: DN20612

CERTIFICATIONS :

# DN23286 Joseph, Jobin

NPI: 1669883856 LIC: DN23286

CERTIFICATIONS :

# HAD95 Lara, Julio

NPI: 1114454915 LIC: HAD95

CERTIFICATIONS :

# DN17431 Leon, Ana

NPI: 1578762332 LIC: DN17431

CERTIFICATIONS :

• Inhalation Sedation

# DN23805 Najafi, Gina

NPI: 1699259291 LIC: DN23805

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

# DN24498 Popek, Barbara

NPI: 1740320993 LIC: DN24498

CERTIFICATIONS :

#FQHC012069

Tampa Family Health Centers,

Inc.

6216 E. Sligh Ave

Tampa, FL 33617

(813) 397-5300M-T 8am-5pm

W-F 8am-5pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

#FQHC012070

Tampa Family Health Centers,

Inc.

302 W. Fletcher Ave

Tampa, FL 33612

tampafamilyhc.com

(813) 397-5305

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN23286 Joseph, Jobin

NPI: 1669883856 LIC: DN23286

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

#FQHC10200

Tampa Family Health Centers,

Inc.

4620 N. 22Nd St

Tampa, FL 33610

tampafamilyhc.com

(813) 397-5300

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

S 8am - 1pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN20612 Jean, Darlene

NPI: 1528474822 LIC: DN20612

CERTIFICATIONS :

# DN17431 Leon, Ana

NPI: 1578762332 LIC: DN17431

CERTIFICATIONS :

• Inhalation Sedation

# DN23805 Najafi, Gina

NPI: 1699259291 LIC: DN23805

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

#FQHC10201

Tampa Family Health Centers,

Inc.

7814 N. Dale Mabry Hwy

Tampa, FL 33614

tampafamilyhc.com

(813) 397-5300

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 15 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 16: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN20612 Jean, Darlene

NPI: 1528474822 LIC: DN20612

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

#FQHC10202

Tampa Family Health Centers,

Inc.

1502 E. Fowler Ave

Tampa, FL 33612

tampafamilyhc.com

(813) 397-5300

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN17431 Leon, Ana

NPI: 1578762332 LIC: DN17431

CERTIFICATIONS :

• Inhalation Sedation

# DN23805 Najafi, Gina

NPI: 1699259291 LIC: DN23805

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

#FQHC10203

Tampa Family Health Centers,

Inc.

3901 S. West Shore Blvd

Tampa, FL 33611

(813) 397-5300

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN20612 Jean, Darlene

NPI: 1528474822 LIC: DN20612

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

#FQHC10204

Tampa Family Health Centers,

Inc.

8108 N. Nebraska Ave

Tampa, FL 33604

(813) 397-5300

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN13067 Gamble, Isolda

NPI: 1992764484 LIC: DN13067

CERTIFICATIONS :

# DN4964 Graddy, Nathan

NPI: 1225318025 LIC: DN4964

CERTIFICATIONS :

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN20612 Jean, Darlene

NPI: 1528474822 LIC: DN20612

CERTIFICATIONS :

# DN17431 Leon, Ana

NPI: 1578762332 LIC: DN17431

CERTIFICATIONS :

• Inhalation Sedation

# DN23805 Najafi, Gina

NPI: 1699259291 LIC: DN23805

CERTIFICATIONS :

# DN24080 Ogunbameru, Aderonke

NPI: 1962827196 LIC: DN24080

CERTIFICATIONS :

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

#FQHC10205

Tampa Family Health Centers,

Inc.

7608 Causeway Blvd

Tampa, FL 33619

tampafamilyhc.com

(813) 397-5300

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19926 Guerra, William

NPI: 1861749459 LIC: DN19926

CERTIFICATIONS :

# DN20612 Jean, Darlene

NPI: 1528474822 LIC: DN20612

CERTIFICATIONS :

# DN17431 Leon, Ana

NPI: 1578762332 LIC: DN17431

CERTIFICATIONS :

• Inhalation Sedation

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

#FQHC010833

Tom Lee Community Health

Center

14254 Martin Luther King Blvd S.R.

574

Dover, FL 33527

(813) 349-7736

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15930 Barlow, Kathleen

NPI: 1164536678 LIC: DN15930

CERTIFICATIONS :

# HAD70 Simeoni, Anna

NPI: 1396817797 LIC: HAD70

CERTIFICATIONS :

ORAL SURGEON

#020259

Dr. Robert Orta D.D.S., P.A

801 W. Dr. Martin Luther Kingjr.

Blvd.

Tampa, FL 33603

(813) 238-0411

English

M-T 8am-5pm

W-F 8am-5pm

# DN14351 Orta, Robert

NPI: 1376681791 LIC: DN14351

CERTIFICATIONS :

• Inhalation Sedation

#009954

Tampa Bay Institute of Oral

Surgery & Dental Implants

7720 W. Waters Ave

Tampa, FL 33615

www.tampabayos.com

(813) 885-6555

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN18163 Aves, Renato

NPI: 1336322650 LIC: DN18163

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN19301 Caribas-Mendible,

Alejandro

NPI: 1013204122 LIC: DN19301

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN23977 Elmohd, Tarik

NPI: 1538556329 LIC: DN23977

CERTIFICATIONS :

# DN21438 Kalsow, Oleg

NPI: 1275951972 LIC: DN21438

CERTIFICATIONS :

# DN19378 Samaniego, Juan

NPI: 1467692129 LIC: DN19378

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

PERIODONTICS

#011547

Brandon Mall Dental PA

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 16 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 17: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

675 Brandon Town Center Mall

Brandon, FL 33511

(813) 681-8600

English, Russian, Spanish

T 10am - 4pm

W 10am-5pm, Th 10am-6pm,F

11am-6pm

S 9am - 5pm, Su 10am - 5pm

# DN13591 Nielsen, Pamela

NPI: 1124118245 LIC: DN13591

CERTIFICATIONS :

INDIAN RIVER COUNTY

DENTIST

#FQHC016045

Treasure Coast Community

Health, Inc

1955 21St Ave

Vero Beach, FL 32960

www.tcchinc.org

(772) 257-8224

English, Spanish

M 8am - 6pm, T 8am - 5pm

W 8am-5pm, Th 7am-4pm,F 8am-3pm

S 8am - 3pm

# DN23968 Arana, Raisa

NPI: 1386209914 LIC: DN23968

CERTIFICATIONS :

# DN13036 Bongato, Zenaida

NPI: 1922046176 LIC: DN13036

CERTIFICATIONS :

#FQHC7649

Treasure Coast Community

Health, Inc

12196 County Road, # 512

Fellsmere, FL 32948

www.tcchinc.org

(772) 257-8224

English, Spanish

M-T 8am-5pm

W 7am-4pm, Th 8am-6pm,F 8am-3pm

S 8am - 3pm

# DN16693 Davis, Robert

NPI: 1770585275 LIC: DN16693

CERTIFICATIONS :

# DN18780 Dietz, Cristen

NPI: 1558590851 LIC: DN18780

CERTIFICATIONS :

# HAD63 Kestranek, John

NPI: 1851437354 LIC: HAD63

CERTIFICATIONS :

# DN12337 Knowles, Norman

NPI: 1588766513 LIC: DN12337

CERTIFICATIONS :

• Conscious Sedation

# DN9654 Kronick, Neil

NPI: 1538179528 LIC: DN9654

CERTIFICATIONS :

# 019029133 Marijanovic, Christine

NPI: 1538414073 LIC: 019029133

CERTIFICATIONS :

• Inhalation Sedation

# DN21185 McAndrew, Matthew

NPI: 1194104646 LIC: DN21185

CERTIFICATIONS :

#FQHC7650

Treasure Coast Community

Health, Inc

1545 9Th St Sw

Vero Beach, FL 32962

www.tcchinc.org

(772) 257-8224

English, Spanish

M 8am - 5pm, T 7am - 4pm

W 8am-6pm, Th 8am-5pm,F 8am-3pm

S 8am - 3pm

# DN23968 Arana, Raisa

NPI: 1386209914 LIC: DN23968

CERTIFICATIONS :

# DN13036 Bongato, Zenaida

NPI: 1922046176 LIC: DN13036

CERTIFICATIONS :

# DN16693 Davis, Robert

NPI: 1770585275 LIC: DN16693

CERTIFICATIONS :

# DN18780 Dietz, Cristen

NPI: 1558590851 LIC: DN18780

CERTIFICATIONS :

# DN22364 Gaponiuk, Mark

NPI: 1003012212 LIC: DN22364

CERTIFICATIONS :

# DN8390 Goebel, Gerald

NPI: 1245384619 LIC: DN8390

CERTIFICATIONS :

# HAD63 Kestranek, John

NPI: 1851437354 LIC: HAD63

CERTIFICATIONS :

# DN12337 Knowles, Norman

NPI: 1588766513 LIC: DN12337

CERTIFICATIONS :

• Conscious Sedation

# DN9654 Kronick, Neil

NPI: 1538179528 LIC: DN9654

CERTIFICATIONS :

# 019029133 Marijanovic, Christine

NPI: 1538414073 LIC: 019029133

CERTIFICATIONS :

• Inhalation Sedation

# DN21185 McAndrew, Matthew

NPI: 1194104646 LIC: DN21185

CERTIFICATIONS :

ORAL SURGEON

#FQHC7649

Treasure Coast Community

Health, Inc

12196 County Road, # 512

Fellsmere, FL 32948

www.tcchinc.org

(772) 257-8224

English, Spanish

M-T 8am-5pm

W 7am-4pm, Th 8am-6pm,F 8am-3pm

S 8am - 3pm

# HAD61 Carlin, Richard

NPI: 1902959414 LIC: HAD61

CERTIFICATIONS :

JACKSON COUNTY

DENTIST

#020298

Larry J. Small DMD Family

Dentistry

2822 Highway 71 Ste H

Marianna, FL 32446

(850) 272-9393

English

T 8am - 5pm

W-Th 8am-5pm

# DN10981 Small, Larry

NPI: 1033133475 LIC: DN10981

CERTIFICATIONS :

#FQHC016581

PanCare of Florida, Inc.

4126 Independent Dr.

Marianna, FL 32448

(850) 394-4907

English

M-T 8am-5pm

W-F 8am-5pm

# DN19128 Claussen, Meghann

NPI: 1336454651 LIC: DN19128

CERTIFICATIONS :

# DN13094 Hudon, Richard

NPI: 1245336031 LIC: DN13094

CERTIFICATIONS :

# DN22620 Knowles, Laura

NPI: 1346778412 LIC: DN22620

CERTIFICATIONS :

# DN23419 Lindsay, Sean

NPI: 1477046290 LIC: DN23419

CERTIFICATIONS :

# DN21740 Moffa, Michelle

NPI: 1841277407 LIC: DN21740

CERTIFICATIONS :

# DN19745 Norton, Andrew

NPI: 1861754020 LIC: DN19745

CERTIFICATIONS :

# HAD73 Pankuch, Richard

NPI: 1467452847 LIC: HAD73

CERTIFICATIONS :

# DN21660 Piorkowski, Gary

NPI: 1699705434 LIC: DN21660

CERTIFICATIONS :

# DN23084 Santos, Iris

NPI: 1487875233 LIC: DN23084

CERTIFICATIONS :

# HAD69 Smith, Amy

NPI: 1831209899 LIC: HAD69

CERTIFICATIONS :

# HAD65 Wilhite, Rhonda

NPI: 1952496341 LIC: HAD65

CERTIFICATIONS :

# DN22573 Williams, Sean

NPI: 1306376512 LIC: DN22573

CERTIFICATIONS :

ORAL SURGEON

#010535

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 17 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 18: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Oral & Facial Surgery Center of

Marianna

4293 Lafayette St

Marianna, FL 32446

(850) 386-4602

English, Spanish

W 9am-3pm,

# DN17462 Tolley, Barrett

NPI: 1356362149 LIC: DN17462

CERTIFICATIONS :

• Board Certification

• General Anesthesia

LAKE COUNTY

DENTIST

#022327

Advanced Children's Dentistry

1020 W. Highway 50

Clermont, FL 34711

(352) 404-5105

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S-Su 9am-5pm

# DN24202 Abed, Ajmal

NPI: 1023429255 LIC: DN24202

CERTIFICATIONS :

#015274

Central Florida Dental Care, LLC

2390 W. Old Hwy 441, Ste 2

Mount Dora, FL 32757

(352) 735-5255

English

M-T 9am-5pm

W-F 9am-5pm

# DN12237 Figaro, Mark

NPI: 1952516965 LIC: DN12237

CERTIFICATIONS :

# DN13227 Johary, Carlos

NPI: 1336338755 LIC: DN13227

CERTIFICATIONS :

#018925

Chun In Lin

404 N. Perkins St.

Leesburg, FL 34748

(352) 314-0888

English, Mandarin Chinese

M-T 8am-4pm

# DN8719 Lin, Chun

NPI: 1568504702 LIC: DN8719

CERTIFICATIONS :

#FQHC022358

Community Health Centers, Inc

225 N. 1St Street

Leesburg, FL 34748

(407) 905-8827M-T 8am-5pm

W-F 8am-5pm

# DN12870 Browning, Lisa

NPI: 1457570103 LIC: DN12870

CERTIFICATIONS :

# DN16298 Chery, Pascale

NPI: 1235138439 LIC: DN16298

CERTIFICATIONS :

# DN13946 Estrada, Luis

NPI: 1245258565 LIC: DN13946

CERTIFICATIONS :

• Inhalation Sedation

# DN19362 Gonzalez, Patricia

NPI: 1760633739 LIC: DN19362

CERTIFICATIONS :

• Inhalation Sedation

# DN7872 Juliao, Carl

NPI: 1992930770 LIC: DN7872

CERTIFICATIONS :

# DN15208 Mcdowell-Travis, Janet

NPI: 1992072540 LIC: DN15208

CERTIFICATIONS :

# DN19016 Munguba, Bozena

NPI: 1043530462 LIC: DN19016

CERTIFICATIONS :

# DN18690 Nguyen, Kathleen

NPI: 1013143544 LIC: DN18690

CERTIFICATIONS :

• Inhalation Sedation

# DN15582 Nicola, Rania

NPI: 1033186986 LIC: DN15582

CERTIFICATIONS :

# DN11858 Palomeque, Theresa

NPI: 1386618544 LIC: DN11858

CERTIFICATIONS :

• Inhalation Sedation

# DN12387 Poveromo, Marc

NPI: 1780745141 LIC: DN12387

CERTIFICATIONS :

• Inhalation Sedation

# DN22449 Stewart, Elizabeth

NPI: 1891155271 LIC: DN22449

CERTIFICATIONS :

# DN10172 Stewart, Gregg

NPI: 1619977733 LIC: DN10172

CERTIFICATIONS :

# DN16458 Teodoru, Catalin

NPI: 1407854847 LIC: DN16458

CERTIFICATIONS :

# DN13300 Velez-Leon, Waleska

NPI: 1316040819 LIC: DN13300

CERTIFICATIONS :

# DN23384 Vo, Tina

NPI: 1548754849 LIC: DN23384

CERTIFICATIONS :

# DN18247 Wray, Roger

NPI: 1528026630 LIC: DN18247

CERTIFICATIONS :

#CHC10282

DOH - Lake County Health

Department

875 Oakley Seaver Dr

Clermont, FL 34711

(352) 989-9001

English

M 9am - 6pm,

# DN19269 Caraballo, Enid

NPI: 1225178973 LIC: DN19269

CERTIFICATIONS :

# DN11984 Gonzalez, Jose

NPI: 1992706691 LIC: DN11984

CERTIFICATIONS :

#022844

Leesburg Smiles LLC

8301 County Road 44 Leg A

Leesburg, FL 34788

(352) 504-0659

English, Arabic, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17585 Mousa, Ammar

NPI: 1962413781 LIC: DN17585

CERTIFICATIONS :

#FQHC7969

South Lake Dental (Community

Health Ctr)

1296 W. Broad Street

Groveland, FL 34736

(407) 905-8827

Spanish

M-T 8am-6pm

W-Th 8am-5pm

# DN12870 Browning, Lisa

NPI: 1457570103 LIC: DN12870

CERTIFICATIONS :

# DN16298 Chery, Pascale

NPI: 1235138439 LIC: DN16298

CERTIFICATIONS :

# DN13946 Estrada, Luis

NPI: 1245258565 LIC: DN13946

CERTIFICATIONS :

• Inhalation Sedation

# DN19362 Gonzalez, Patricia

NPI: 1760633739 LIC: DN19362

CERTIFICATIONS :

• Inhalation Sedation

# DN16458 Teodoru, Catalin

NPI: 1407854847 LIC: DN16458

CERTIFICATIONS :

# DN23384 Vo, Tina*

NPI: 1548754849 LIC: DN23384

CERTIFICATIONS :

LEE COUNTY

DENTIST

#021857

Happy Smiles of Fort Myers

2675 Winkler Ave, Unit 150

Fort Myers, FL 33901

happysmilesfortmyers.com

(239) 204-2780

English, Russian, Spanish

M 10am - 5pm, T 9am - 5pm

W 9am-5pm, Th 9am-4pm,F 9am-3pm

# DN24614 Cerrutti, Juan

NPI: 1992233167 LIC: DN24614

CERTIFICATIONS :

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN23454 Nguyen, Michelle

NPI: 1033603733 LIC: DN23454

CERTIFICATIONS :

• Inhalation Sedation

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 18 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 19: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN24429 Shahriari, Varahram

NPI: 1952954778 LIC: DN24429

CERTIFICATIONS :

# DN16481 Zadov, Marianna

NPI: 1104903301 LIC: DN16481

CERTIFICATIONS :

• Inhalation Sedation

#010481

Picasso Aesthetic & Cosmetic

Dental Spa

9776 Bonita Beach Road Ste 202A

Bonita Springs, FL 34135

(239) 405-3997

English

M-T 9am-5pm

W-F 9am-5pm

# DN12852 Rubin, Jeffrey*

NPI: 1073520789 LIC: DN12852

CERTIFICATIONS :

PERIODONTICS

#021857

Happy Smiles of Fort Myers

2675 Winkler Ave, Unit 150

Fort Myers, FL 33901

happysmilesfortmyers.com

(239) 204-2780

English, Russian, Spanish

M 10am - 5pm, T 9am - 5pm

W 9am-5pm, Th 9am-4pm,F 9am-3pm

# DN23115 Mendoza, Juan

NPI: 1821326430 LIC: DN23115

CERTIFICATIONS :

• Inhalation Sedation

# DN11699 Simon, David

NPI: 1508303587 LIC: DN11699

CERTIFICATIONS :

• Oral / Enteral Sedation

LEON COUNTY

DENTIST

#FQHC010635

Bond Community Health Center,

Inc.

1720 S. Gadsden St, Ste 219

Tallahassee, FL 32301

(850) 521-5121

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN9380 Manocha, Ashok

NPI: 1467669606 LIC: DN9380

CERTIFICATIONS :

# DN7339 Tolley, Leonard

NPI: 1902822497 LIC: DN7339

CERTIFICATIONS :

#FQHC014446

Neighborhood Medical Center Inc.

872 W.Orange Ave

Tallahassee, FL 32310

www.neighborhoodmedicalcenter.org

(850) 577-0435

English, Spanish, Swahili

M-T 7am-6pm

W-F 7am-6pm

# DN22475 Butler, Latoya

NPI: 1003357351 LIC: DN22475

CERTIFICATIONS :

# DN19383 Garraway, Chinara

NPI: 1629364153 LIC: DN19383

CERTIFICATIONS :

# HAD84 Hall, Shai

NPI: 1013043637 LIC: HAD84

CERTIFICATIONS :

# DN20236 Laing, Christopher

NPI: 1356696272 LIC: DN20236

CERTIFICATIONS :

# DN18939 Thiry, Warren

NPI: 1477871697 LIC: DN18939

CERTIFICATIONS :

#FQHC018638

Neighborhood Medical Center Inc.

3013 Jim Lee Road

Tallahassee, FL 32301

www.neighborhoodmedicalcenter.org

(850) 224-2469

English, Spanish

M-T 7am-6pm

W-F 7am-6pm

# DN22475 Butler, Latoya

NPI: 1003357351 LIC: DN22475

CERTIFICATIONS :

# DN19383 Garraway, Chinara

NPI: 1629364153 LIC: DN19383

CERTIFICATIONS :

# HAD84 Hall, Shai

NPI: 1013043637 LIC: HAD84

CERTIFICATIONS :

# DN20236 Laing, Christopher

NPI: 1356696272 LIC: DN20236

CERTIFICATIONS :

# DN18939 Thiry, Warren

NPI: 1477871697 LIC: DN18939

CERTIFICATIONS :

MANATEE COUNTY

DENTIST

#FQHC015357

Lawton Chiles Dental

1515 26Th Ave East

Bradenton, FL 34208

(941) 708-7607

English, Spanish

M 8am - 8pm, T 8am - 5pm

W-F 8am-5pm

# DN21300 Alonso, Anamevys

NPI: 1669868147 LIC: DN21300

CERTIFICATIONS :

# DN19659 Cherry, Jerry

NPI: 1700172129 LIC: DN19659

CERTIFICATIONS :

# DN18543 Keo, Phanith

NPI: 1285828491 LIC: DN18543

CERTIFICATIONS :

# DN13120 Martinez, Susana

NPI: 1215015144 LIC: DN13120

CERTIFICATIONS :

# HAD99 Potts-Williams, Madge

NPI: 1902028780 LIC: HAD99

CERTIFICATIONS :

# DN19389 Sanchez, Arnaldo

NPI: 1831486844 LIC: DN19389

CERTIFICATIONS :

#011168

LeCom School of Dental Medicine

4800 Lakewood Ranch Blvd

Bradenton, FL 34211

(941) 405-1600

English, Arabic, Russian, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN19387 Manibo, Lourdes

Alexandra

NPI: 1730312760 LIC: DN19387

CERTIFICATIONS :

# DN8944 Ottenga, Marc

NPI: 1306802293 LIC: DN8944

CERTIFICATIONS :

• Inhalation Sedation

# DTP651 Supczenski, John

NPI: 1538159934 LIC: DTP651

CERTIFICATIONS :

#M013843

Manatee County Rural Health

Serv, - Health Express (Mobile)

12271 Us Hwy 301 N

Parrish, FL 34219

(941) 713-2081

English

# DN21300 Alonso, Anamevys

NPI: 1669868147 LIC: DN21300

CERTIFICATIONS :

# DN19659 Cherry, Jerry

NPI: 1700172129 LIC: DN19659

CERTIFICATIONS :

# DN18543 Keo, Phanith

NPI: 1285828491 LIC: DN18543

CERTIFICATIONS :

# DN13120 Martinez, Susana

NPI: 1215015144 LIC: DN13120

CERTIFICATIONS :

# DN19389 Sanchez, Arnaldo

NPI: 1831486844 LIC: DN19389

CERTIFICATIONS :

#FQHC015356

Manatee Village Dental Center

1312 Manatee Ave East

Bradenton, FL 34208

(941) 708-8710

English, Spanish

M 8am - 8pm, T 8am - 5pm

Th-F 8am-5pm

# DN21300 Alonso, Anamevys

NPI: 1669868147 LIC: DN21300

CERTIFICATIONS :

# DN19659 Cherry, Jerry

NPI: 1700172129 LIC: DN19659

CERTIFICATIONS :

# DN18543 Keo, Phanith

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 19 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 20: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1285828491 LIC: DN18543

CERTIFICATIONS :

# DN13120 Martinez, Susana

NPI: 1215015144 LIC: DN13120

CERTIFICATIONS :

# DN19389 Sanchez, Arnaldo

NPI: 1831486844 LIC: DN19389

CERTIFICATIONS :

#020059

Montiel Dental Care PA

6818 14Th St W

Bradenton, FL 34207

(941) 782-8058

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 9am - 6pm

# DN23640 Moreno Montiel, Yuliet

NPI: 1841786647 LIC: DN23640

CERTIFICATIONS :

#011207

Ward Family Dental, PA

1619 Tallevast Road

Tallevast, FL 34270

(941) 355-4800

English, Spanish, French

M-T 4pm-7pm

W-Th 4pm-7pm

S 9am - 1pm

# DN5019 Ward, Clifford*

NPI: 1386856615 LIC: DN5019

CERTIFICATIONS :

# DN17405 Ward, Tasha*

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

MARION COUNTY

DENTIST

#CHC10191

DOH - Marion County Health

Department

1501 W Silver Springs Blvd

Ocala, FL 34475

(352) 622-2664

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

# DN11663 Bridges, Catherine

NPI: 1659309821 LIC: DN11663

CERTIFICATIONS :

# 23871 Miller, Howard

NPI: 1538159363 LIC: 23871

CERTIFICATIONS :

# DN21699 Spenn, Jonathan

NPI: 1942435318 LIC: DN21699

CERTIFICATIONS :

#FQHC011141

Heart of Florida Health Center

1025 Sw 1St Ave

Ocala, FL 34471

(352) 732-6599

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN23944 Batista, Claudia

NPI: 1447747449 LIC: DN23944

CERTIFICATIONS :

# DN23942 Cameron, Casey

NPI: 1548758147 LIC: DN23942

CERTIFICATIONS :

# DN15057 Greenwald, Lara

NPI: 1417126699 LIC: DN15057

CERTIFICATIONS :

#FQHC10256

Langley Health Services

7205 Se Maricamp Rd

Ocala, FL 34472

(352) 680-7011

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN19878 Clinton, Edna

NPI: 1376853929 LIC: DN19878

CERTIFICATIONS :

• Inhalation Sedation

# DN14803 Worthy, Michele

NPI: 1023196169 LIC: DN14803

CERTIFICATIONS :

• Inhalation Sedation

MARTIN COUNTY

DENTIST

#FQHC020246

Florida Community Health

Centers, Inc.

15858 Sw Warfield Blvd

Indiantown, FL 34956

www.fchcinc.org

(772) 597-3596

English, Spanish

M 8am - 6pm, T 8am - 5pm

W-Th 8am-5pm

# DN20720 Blackwood, Alberto

NPI: 1487057303 LIC: DN20720

CERTIFICATIONS :

# DN13607 Morales, Carlos

NPI: 1457310559 LIC: DN13607

CERTIFICATIONS :

# DN18121 Palacios, Eric

NPI: 1376778084 LIC: DN18121

CERTIFICATIONS :

# DN13771 Sanchez, Armando

NPI: 1992764930 LIC: DN13771

CERTIFICATIONS :

# DN13207 Zayas, Alida

NPI: 1639148968 LIC: DN13207

CERTIFICATIONS :

#FQHC020248

Florida Community Health

Centers, Inc.

3441 Se Willoughby Blvd

Stuart, FL 34994

(772) 403-5650

English, Spanish, Creoles and Pidgins,

English-based(other)

M 8am - 6pm, T 8am - 5pm

W-Th 8am-5pm

# DN20720 Blackwood, Alberto

NPI: 1487057303 LIC: DN20720

CERTIFICATIONS :

# DN13607 Morales, Carlos

NPI: 1457310559 LIC: DN13607

CERTIFICATIONS :

# DN14000 Naryshkin, George

NPI: 1730395773 LIC: DN14000

CERTIFICATIONS :

# DN18121 Palacios, Eric

NPI: 1376778084 LIC: DN18121

CERTIFICATIONS :

# DN13771 Sanchez, Armando

NPI: 1992764930 LIC: DN13771

CERTIFICATIONS :

# DN13207 Zayas, Alida

NPI: 1639148968 LIC: DN13207

CERTIFICATIONS :

MIAMI-DADE COUNTY

DENTIST

#011900

A & R Dental Center of Hialeah

765 E 9 St

Hialeah, FL 33010

(305) 883-4880

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN19137 Cuenca, Annie

NPI: 1871806273 LIC: DN19137

CERTIFICATIONS :

# DN19107 Rodriguez, Rene

NPI: 1942513122 LIC: DN19107

CERTIFICATIONS :

#007543

AB Dentistry Inc

9840 Sw 40Th St

Miami, FL 33165

(305) 223-0420

English, Spanish

M 9am - 6pm, T 9am - 1pm

F 9am-1pm

# DN16665 Betancourt, Arely

NPI: 1265528897 LIC: DN16665

CERTIFICATIONS :

#013660

Ace Smiles Dental Associates

14138 Sw 8Th St Ste #1

Miami, FL 33184

(786) 717-7779

English, Spanish, French

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN18576 Mendoza, Irenia

NPI: 1124256920 LIC: DN18576

CERTIFICATIONS :

• Inhalation Sedation

#021748

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 20 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 21: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Acuario Dental Group

4355 W. 16 Ave, Ste 205A

Hialeah, FL 33012

(786) 800-9507

English, Spanish

M 9am - 7pm, T 9am - 2pm

W-Th 9am-7pm

S 9am - 3pm

# 14821 Ayala, Rita

NPI: 1619090289 LIC: 14821

CERTIFICATIONS :

#013231

Adolfo E. Mares Dental Office

306 Sw 12Ave, Ste B

Miami, FL 33130

(305) 642-0535

Spanish

M-T 10am-5pm

W-F 10am-5pm

# DN12527 Mares, Adolfo

NPI: 1811048937 LIC: DN12527

CERTIFICATIONS :

#009021

Aladino Valiente, DMD, PA

12781 Sw 42Nd Street, Ste D

Miami, FL 33175

www.valientedental.com

(305) 226-7404

Spanish, English

M-T 9am-7pm

W-F 9am-7pm

# DN15599 Valiente, Aladino

NPI: 1609935626 LIC: DN15599

CERTIFICATIONS :

#009529

Alejandro De La Cruz, D.D.S., P.A.

7380 Sw 40 St, Ste B

Miami, FL 33155

(305) 441-2773

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN14560 De la Cruz, Alejandro

NPI: 1013152016 LIC: DN14560

CERTIFICATIONS :

#013603

Alicia B. Cayon, D.M.D., P.A.

8370 W Flagler St Ste 150

Miami, FL 33144

(305) 227-3083

English, Spanish

M 11am - 7pm, T 9am - 5pm

Th-F 9am-5pm

S 9am - 2pm

# DN20679 Cayon, Alicia

NPI: 1467865022 LIC: DN20679

CERTIFICATIONS :

#007563

All Family Care Inc

38 Nw 8Th St

Homestead, FL 33030

(305) 246-0460

English, Spanish, French

M 11am - 7pm, T 9am - 5pm

W 11am-7pm,

# DN12529 Martinez, Jose

NPI: 1780798926 LIC: DN12529

CERTIFICATIONS :

# DN12244 Sanchez, Jorge

NPI: 1568636280 LIC: DN12244

CERTIFICATIONS :

#016126

All In One Dental Services

13728 Sw 84Th Street

Miami, FL 33183

www.aiodentist.com

(305) 456-7383

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 10am - 3pm

# DN17506 Mora, Yosjany

NPI: 1922179613 LIC: DN17506

CERTIFICATIONS :

#012970

Alpha Dental Group

4999 W 8 Ave Ste 1

Hialeah, FL 33012

(786) 953-5943

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN14173 Bobadilla, Patricia

NPI: 1124039672 LIC: DN14173

CERTIFICATIONS :

#021615

Alpha Dental Group 2

5870 Sw 8 Street, Ste 4

Miami, FL 33144

(305) 392-1261

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN14173 Bobadilla, Patricia

NPI: 1124039672 LIC: DN14173

CERTIFICATIONS :

# DN23695 Cruz, Yanet

NPI: 1508225376 LIC: DN23695

CERTIFICATIONS :

#006690

Amaury Rodriguez, DDS

3944 W. Flagler Street

Miami, FL 33134

(305) 445-1405

Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN12779 Rodriguez, Amaury

NPI: 1437251568 LIC: DN12779

CERTIFICATIONS :

#014267

Amazing Touch Dental Care Corp

1955 W. 68Th St

Hialeah, FL 33014

(786) 257-1646

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN11884 Soler, Rosa

NPI: 1083738652 LIC: DN11884

CERTIFICATIONS :

#013162

America Dental Clinic

3631 Sw 87Th Ave

Miami, FL 33165

(305) 485-8427

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN20289 Soto Mendez, Lisbet

NPI: 1679915953 LIC: DN20289

CERTIFICATIONS :

# DN17931 Toirac, Maria

NPI: 1790987543 LIC: DN17931

CERTIFICATIONS :

#012979

Aponte Dental Corp

1350 Sw 57 Ave Ste 106

Miami, FL 33144

(305) 265-6120

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN20182 Aponte-Barrios, Secil

NPI: 1164714176 LIC: DN20182

CERTIFICATIONS :

#021793

A-Z Dental Inc

5924 West 16Th Ave

Hialeah, FL 33012

(305) 558-2133

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 5pm

# DN14173 Bobadilla, Patricia

NPI: 1124039672 LIC: DN14173

CERTIFICATIONS :

#008228

Becerra's Family Dentistry

936 Sw 82Nd Ave Ste 936

Miami, FL 33144

(305) 269-1440

English, Spanish

M 9am - 6pm, T 8am - 8pm

W 9am-5pm, Th 9am-6pm,F 9am-5pm

# DN15934 Becerra, Maria

NPI: 1598841405 LIC: DN15934

CERTIFICATIONS :

#012298

Best Family Dental

5190 Nw 167 St #216

Miami Gardens, FL 33014

(305) 624-4114

English, Spanish

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 21 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 22: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

M-T 9am-5pm

W-Th 9am-5pm

# DN12269 Blay, Marina

NPI: 1932425972 LIC: DN12269

CERTIFICATIONS :

# DN6340 Drobes, David

NPI: 1740478221 LIC: DN6340

CERTIFICATIONS :

# DN19881 Hernandez-Jerez, Gema

NPI: 1699020347 LIC: DN19881

CERTIFICATIONS :

#CHC8227

Borinquen Health Care Center,

INC

3601 Federal Hwy, 5Th Floor

Miami, FL 33137

(305) 576-6611

English, Spanish, Creoles and Pidgins,

Portuguese-based(other), French,

Persian (T), Portuguese

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-4pm

S 8am - 2pm

# DN19839 Gutierrez, Carlos

NPI: 1861756603 LIC: DN19839

CERTIFICATIONS :

• Inhalation Sedation

# DN19140 Mestre, Jairo

NPI: 1811202971 LIC: DN19140

CERTIFICATIONS :

• Inhalation Sedation

# DN19249 Pria, Carlos

NPI: 1811166838 LIC: DN19249

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN16074 Soheil, Michelle

NPI: 1215014394 LIC: DN16074

CERTIFICATIONS :

#FQHC017137

Borinquen Health Care Center,

Inc.

708 Ne 125Th St

North Miami, FL 33161

(305) 576-6611

English, Farsi, French, Spanish

M-T 8am-5pm

W-Th 8am-5pm

S 8am - 2pm

# DN19839 Gutierrez, Carlos

NPI: 1861756603 LIC: DN19839

CERTIFICATIONS :

• Inhalation Sedation

# DN19249 Pria, Carlos

NPI: 1811166838 LIC: DN19249

CERTIFICATIONS :

• Board Certification

• Inhalation Sedation

# DN16074 Soheil, Michelle

NPI: 1215014394 LIC: DN16074

CERTIFICATIONS :

#009814

Bravo Dental P.A.

909 N. Miami Beach Blvd, Ste 501

North Miami Beach, FL 33162

(305) 945-9333

English, Spanish

M-T 10am-5pm

W-F 10am-5pm

# DN19497 Yanez Bravo, Maria

NPI: 1891074183 LIC: DN19497

CERTIFICATIONS :

• Inhalation Sedation

#018293

Broward Mall Dental

1334 Sw 1St St

Miami, FL 33135

(305) 230-4426M-T 8am-4pm

W-F 8am-4pm

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN10511 Green, George

NPI: 1609094580 LIC: DN10511

CERTIFICATIONS :

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

# DN22713 Morell, Omar

NPI: 1659801587 LIC: DN22713

CERTIFICATIONS :

# DN18770 Trujillo, Madelene

NPI: 1881835767 LIC: DN18770

CERTIFICATIONS :

#011430

C & C Dental, Inc.

951 Ne 167 Street, #104

North Miami Beach, FL 33162

(305) 493-9371

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN19495 Casas, Silvia

NPI: 1912295387 LIC: DN19495

CERTIFICATIONS :

#FQHC012553

Camillus Health Concern, Inc.

336 Nw 5Th St

Miami, FL 33128

(305) 341-0152

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN9529 Alfonso, Rafael

NPI: 1669546784 LIC: DN9529

CERTIFICATIONS :

# DN15957 De la Torre, Carmen

NPI: 1093892150 LIC: DN15957

CERTIFICATIONS :

#016489

Care Resource

1901 Sw 1St St

Miami, FL 33135

(305) 203-5230

English

M-T 8am-5pm

Th-F 8am-5pm

# DN13731 Barnes, Curtis

NPI: 1689798936 LIC: DN13731

CERTIFICATIONS :

# DN18139 Casas, Manuel

NPI: 1740420090 LIC: DN18139

CERTIFICATIONS :

# DN20973 Martinez, Amy

NPI: 1124382866 LIC: DN20973

CERTIFICATIONS :

# DN20674 Sardinas, Yoan

NPI: 1992118657 LIC: DN20674

CERTIFICATIONS :

#021891

Care Smile, LLC

833 N. Homestead Blvd

Homestead, FL 33030

(305) 245-3247

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

# DN18847 De Vera, Vanessa

NPI: 1699006072 LIC: DN18847

CERTIFICATIONS :

# DN20903 Gomez Perez, Nils

NPI: 1346649118 LIC: DN20903

CERTIFICATIONS :

#021892

Care Smile, LLC

9605 W. Flagler Street

Miami, FL 33174

(305) 559-0278

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

# DN18847 De Vera, Vanessa

NPI: 1699006072 LIC: DN18847

CERTIFICATIONS :

# DN20903 Gomez Perez, Nils

NPI: 1346649118 LIC: DN20903

CERTIFICATIONS :

#021893

Care Smile, LLC

1840 W. 49Th Street, Ste 105

Hialeah, FL 33012

(305) 362-4382

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

# DN18847 De Vera, Vanessa

NPI: 1699006072 LIC: DN18847

CERTIFICATIONS :

# DN20903 Gomez Perez, Nils

NPI: 1346649118 LIC: DN20903

CERTIFICATIONS :

#021894

Care Smile, LLC

1757 Sw 22Nd Street

Miami, FL 33145

(786) 442-1040

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 22 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 23: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-5pm

W-F 8am-5pm

# DN18847 De Vera, Vanessa

NPI: 1699006072 LIC: DN18847

CERTIFICATIONS :

# DN20903 Gomez Perez, Nils

NPI: 1346649118 LIC: DN20903

CERTIFICATIONS :

#006607

Cecilia Maria Rey, DDS PA

4790 Nw 7Th Street, Ste 210/211

Miami, FL 33126

(305) 448-2014

Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN14776 Rey, Cecilia

NPI: 1588872006 LIC: DN14776

CERTIFICATIONS :

#FQHC016391

CFCE Pediatric & Family Health

& Wellness

1825 Nw 167 St Ste 102

Miami Gardens, FL 33056

(305) 474-1800

English, Spanish, Creoles and Pidgins

(other)

M 9am - 5pm, T 10am - 7pm

Th-F 9am-5pm

# DN21844 Brunet, Zeida

NPI: 1093164956 LIC: DN21844

CERTIFICATIONS :

# DN21846 Fonseca, Jacqueline

NPI: 1487005369 LIC: DN21846

CERTIFICATIONS :

#008230

Ciro A. Martin, DDS, PA

8463 Bird Road

Miami, FL 33155

(305) 551-6714

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN13508 Martin, Ciro

NPI: 1093855256 LIC: DN13508

CERTIFICATIONS :

#011421

Claudio L. Miro DDS

564 Sw 42 Ave, 2Nd Floor

Miami, FL 33134

(305) 442-7444

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN21293 Merikas, Amanda

NPI: 1669853305 LIC: DN21293

CERTIFICATIONS :

# DN11650 Miro, Claudio

NPI: 1417024118 LIC: DN11650

CERTIFICATIONS :

• Conscious Sedation

# DN16786 Miro, Kiara

NPI: 1427078625 LIC: DN16786

CERTIFICATIONS :

# DN16862 Trujillo, Alexander

NPI: 1043231996 LIC: DN16862

CERTIFICATIONS :

• Conscious Sedation

#FQHC7698

Clinica Campesina

810 West Mowry Dr.

Homestead, FL 33030

(305) 242-6078

English, Spanish, Creoles and Pidgins,

French-based(other)

M 8am - 7pm, T 8am - 5pm

W 8am-7pm, Th 8am-5pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#019446

Collazo Family Dental

285 Nw 27Th Ave Ste 21

Miami, FL 33125

(786) 238-7590

English, Spanish

M 10am - 6pm,

S 10am - 2pm

# DN20751 Ramos Collazo, Yoaris

NPI: 1679982748 LIC: DN20751

CERTIFICATIONS :

#FQHC7697

Community Health Center

10300 Sw 216Th Street

Miami, FL 33190

(305) 253-5100

English, Chinese Mandarin, Creoles

and Pidgins, English-based(other),

French, Polish, Spanish

M-T 8am-7pm

W-Th 8am-7pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN22552 Ramirez Gonzalez,

Carmen

NPI: 1134659543 LIC: DN22552

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#FQHC014565

Community Health of South

Florida, Inc.

13540 Sw 135 Ave

Miami, FL 33186

www.chisouthfl.org

(786) 231-0800

English, Spanish

T 8am - 6pm

W-F 8am-6pm

S 8am - 12pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 23 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 24: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#FQHC014566

Community Health of South

Florida, Inc.

6350 Sunset Drive

Miami, FL 33143

(786) 293-5500

English, Spanish, Creoles and Pidgins,

English-based(other)

M 8am - 5pm, T 10am - 7pm

W 8am-5pm, Th 10am-7pm,F

8am-5pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#022054

Coral Gables Dental Health

Center

747 Ponce De Leon Blvd, Ste 401

Miami, FL 33134

(305) 444-8591

English, Spanish

M-T 10am-7pm

W-Th 10am-7pm

# DN16140 Carballo, Rodolfo

NPI: 1235466269 LIC: DN16140

CERTIFICATIONS :

#007940

Crown Dental Corp

10728 Sw 72Nd Street

Miami, FL 33173

(305) 596-7155

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 1pm

# DN12593 Gonzalez, Lilian

NPI: 1255436424 LIC: DN12593

CERTIFICATIONS :

#011899

D & R Dentistry

14750 Sw 26 St Ste 210

Miami, FL 33185

(305) 400-8060

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN18940 Rodriguez, Ramon

NPI: 1366768657 LIC: DN18940

CERTIFICATIONS :

#009364

David E Dewitt, DDS PA

4841 W 4Th Ave

Hialeah, FL 33012

(305) 558-2261

Spanish, English

M 9am - 5pm, T 9am - 6pm

Th-F 9am-2pm

S 9am - 12pm

# DN3920 Dewitt, David

NPI: 1548372139 LIC: DN3920

CERTIFICATIONS :

# DN8463 Vazana, Raphael

NPI: 1528170107 LIC: DN8463

CERTIFICATIONS :

#011412

David M. Adelman, DDS, PA

16680 Ne 10Th Ave

North Miami Beach, FL 33162

(305) 944-6669

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN3881 Adelman, David

NPI: 1215053160 LIC: DN3881

CERTIFICATIONS :

• Inhalation Sedation

#015505

De La Calle Dental Center

10775 Sw 56Th St

Miami, FL 33165

[email protected]

(305) 321-5927

English, Spanish

T 9am - 5pm

W-F 9am-5pm

# DN21153 Lobaina, Karina

NPI: 1063895076 LIC: DN21153

CERTIFICATIONS :

#014323

Deluxe Dental

4005 Sw 152Nd Ave Unit 2

Miami, FL 33185

(786) 409-5295

English, Spanish

M 10am - 6pm, T 1pm - 9pm

W-Th 10am-6pm

# DN20362 Diaz, Farah

NPI: 1861784779 LIC: DN20362

CERTIFICATIONS :

#015414

Dental Dreams LLC

5632 Nw 167Th St

Miami, FL 33014

(305) 625-9777

English, Spanish

M-T 9am-5pm

W 9am-5pm,

S 9am - 1pm

# DN16291 Carpio, Jesus

NPI: 1932281961 LIC: DN16291

CERTIFICATIONS :

#019648

Dental Excellence Partners, LLC

4500 Nw 7Th St

Miami, FL 33126

(305) 443-9206M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#019649

Dental Excellence Partners, LLC

8300 W. Flager Ste 210

Miami, FL 33144

(786) 534-2796M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 24 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 25: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

#019657

Dental Excellence Partners, LLC

3825 W. 16Th Ave

Hialeah, FL 33012

(786) 501-2166

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#019658

Dental Excellence Partners, LLC

6801 Sw 8Th St.

Miami, FL 33144

(786) 501-2168

English

M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#019659

Dental Excellence Partners, LLC

4410 W. 16Th Ave #58

Hialeah, FL 33012

(305) 826-5224

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20182 Aponte-Barrios, Secil

NPI: 1164714176 LIC: DN20182

CERTIFICATIONS :

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#020098

Dental Excellence Partners, LLC

266 E 49Th St

Hialeah, FL 33013

(305) 823-9982

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN23886 Castellanos, Nicholas

NPI: 1497228621 LIC: DN23886

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#020099

Dental Excellence Partners, LLC

5190 Nw 167Th Ave Ste 109

Miami Lakes, FL 33014

(786) 507-3454

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 25 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 26: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#020101

Dental Excellence Partners, LLC

13768 Sw 8Th St

Miami, FL 33184

(786) 501-2163

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN21645 Baez Henry, Carlianette

NPI: 1235594961 LIC: DN21645

CERTIFICATIONS :

# DN22998 Boeras Garcia, Suibel

NPI: 1063939890 LIC: DN22998

CERTIFICATIONS :

# DN15630 Cano, Lourdes

NPI: 1093867947 LIC: DN15630

CERTIFICATIONS :

# DN21572 Carballo, Mauro

NPI: 1508200635 LIC: DN21572

CERTIFICATIONS :

# DN20061 Cruz, Yarelie

NPI: 1124433305 LIC: DN20061

CERTIFICATIONS :

# DN23529 Gonzalez, Giovanni

NPI: 1417436189 LIC: DN23529

CERTIFICATIONS :

# DN19522 Hernandez, Stephanie

NPI: 1669751871 LIC: DN19522

CERTIFICATIONS :

# DN11150 Reyes, Miguel

NPI: 1407948482 LIC: DN11150

CERTIFICATIONS :

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#009925

Dental Group of Miami Beach

1010 71 Street

Miami Beach, FL 33141

(305) 868-8500

English, Spanish

M 10am - 7pm, T 9am - 4pm

W-Th 10am-7pm

# DN19274 Quintana, Vilma

NPI: 1598064354 LIC: DN19274

CERTIFICATIONS :

#008978

Dental Group of South Florida II,

Inc

11336 Sw 184Th St

Miami, FL 33157

(305) 251-4262

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN17638 Alvarez, Maria

NPI: 1124165303 LIC: DN17638

CERTIFICATIONS :

#009361

Dental Group of South Florida III

101 Westward Dr. Ste A

Miami Springs, FL 33166

(305) 885-1357

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN17638 Alvarez, Maria

NPI: 1124165303 LIC: DN17638

CERTIFICATIONS :

#016140

Dental Group of South Florida IV

Inc

11373 Sw 211Th Street, Ste 10

Miami, FL 33189

www.dentalffl.com

(786) 250-5088

English, Spanish

M-T 10am-7pm

W-F 10am-7pm

# DN17638 Alvarez, Maria

NPI: 1124165303 LIC: DN17638

CERTIFICATIONS :

# DN17433 Martinez, Milton

NPI: 1346326972 LIC: DN17433

CERTIFICATIONS :

#022882

Dental Group of South Florida V

16830 Sw 88Th Street

Miami, FL 33196

(305) 388-4886

English, Spanish

M-T 9am-6pm

Th-F 9am-6pm

# DN17638 Alvarez, Maria

NPI: 1124165303 LIC: DN17638

CERTIFICATIONS :

#012990

Dental Plus Inc.

11352 Quail Roost Dr

Miami, FL 33157

(305) 969-2651

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

S 9am - 2pm

# DN19504 Cordova-Pena, Noris*

NPI: 1669754578 LIC: DN19504

CERTIFICATIONS :

#012876

Diana R. Blanco, DMD, PLLC

279 Nw 82 Ave

Miami, FL 33126

(305) 456-4592M-T 10am-6pm

W-F 10am-6pm

S 9am - 3pm

# DN18471 Blanco, Diana

NPI: 1659536043 LIC: DN18471

CERTIFICATIONS :

#CHC014620

DOH - Miami-Dade County

Health Department

971 Nw 2Nd St

Miami, FL 33128

(305) 575-3800

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN12747 Martin, Rosa

NPI: 1538373428 LIC: DN12747

CERTIFICATIONS :

# DN17940 Subirats-Torres, Ibelys

NPI: 1811193972 LIC: DN17940

CERTIFICATIONS :

#007974

Dr. Alfredo Santeiro, DDS

2555 Collins Ave, Ste C3

Miami Beach, FL 33140

www.clubatlantisdental.com

(305) 672-9698

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN12959 Santeiro, Alfredo

NPI: 1669602629 LIC: DN12959

CERTIFICATIONS :

#016275

Dr. Jauregui Dental Care Corp

5757 Sw 8Th Street, Ste 115

Miami, FL 33144

wwwdrjauregui

(305) 269-1781

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21055 Jauregui, Guillermo

NPI: 1124375647 LIC: DN21055

CERTIFICATIONS :

#012061

Dr. Jean-Jacques Edderai, DDS PA

17101 Ne 19Th Ave, Ste 104

North Miami Beach, FL 33162

(305) 947-7999

English, Spanish, French, Hebrew

M-T 9am-5pm

W 9am-5pm, Th 12pm-7pm,F

9am-1pm

# DN12836 Edderai, Jean

NPI: 1598981227 LIC: DN12836

CERTIFICATIONS :

#016113

Dr. Kleber A. Loor, DDS, PA

1450 W. Flagler St

Miami, FL 33135

www.kloordds.com

(305) 649-7800

English, Spanish

M 12pm - 6pm, T 9am - 5pm

W 8am-1pm,

S 8am - 1pm

# DN16772 Loor, Kleber

NPI: 1124037833 LIC: DN16772

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 26 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 27: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#021124

Dr. Zmiles Inc.

2999 Ne 191 St. Ste #602

Aventura, FL 33180

dr-zsmiles.com

(305) 682-1795

English, Russian, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN18673 Trujillo, Zuzel

NPI: 1285860353 LIC: DN18673

CERTIFICATIONS :

#012702

Elizabeth De Aguirre DDS

806 S Douglas Rd Ste 150

Coral Gables, FL 33134

(305) 446-2226

English, Spanish

M 9am - 5pm, T 9am - 6pm

W-Th 9am-6pm

# DN15008 De Aguirre, Elizabeth

NPI: 1467434746 LIC: DN15008

CERTIFICATIONS :

#008275

Elizabeth De Aguirre, D.D.S., P.A.

2750 W. 68 St, Ste 108

Hialeah, FL 33016

(305) 826-3255

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN17647 Bueno, Rosa*

NPI: 1972649218 LIC: DN17647

CERTIFICATIONS :

• Inhalation Sedation

# DN15008 De Aguirre, Elizabeth*

NPI: 1467434746 LIC: DN15008

CERTIFICATIONS :

#017955

Empire Corporation

2030 Nw 22Nd Ave

Miami, FL 33142

(305) 631-2963

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN14173 Bobadilla, Patricia

NPI: 1124039672 LIC: DN14173

CERTIFICATIONS :

# DN21847 Diaz, Jany

NPI: 1659729598 LIC: DN21847

CERTIFICATIONS :

#008286

Enrique Morales, DDS, PC

3009 East 4Th Ave

Hialeah, FL 33013

(305) 691-1616

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN14003 Morales, Enrique

NPI: 1649310319 LIC: DN14003

CERTIFICATIONS :

#011567

Estetica Dental Gables Inc

4411 West Flagler Street

Miami, FL 33134

(305) 445-5515

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN19582 Valdes, Marilyn

NPI: 1104103910 LIC: DN19582

CERTIFICATIONS :

#FQHC7694

Everglades Health Center

19300 Sw 376Th St

Homestead, FL 33034

(305) 246-4607

English, Chinese Mandarin, Creoles

and Pidgins, English-based(other),

French, Polish, Spanish

W 8am-7pm,

S 8am - 12pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#011876

Excellence in Dental Care

3762 W 12Th Ave

Hialeah, FL 33012

(305) 557-6661

English, Spanish

M-T 9am-6pm

W 9am-6am, Th 9am-6pm,F 9am-1pm

# DN17118 Alvarez, Rosa

NPI: 1306944533 LIC: DN17118

CERTIFICATIONS :

#009426

Family and Cometic Dentistry

4300 W. Flagler St Ste 201

Miami, FL 33134

(305) 888-0008

English, Spanish

M-T 11am-6pm

W 11am-6pm, Th 9am-6pm,F

11am-6pm

S 9am - 3pm

# DN11020 Alfonzo, Fara

NPI: 1851447684 LIC: DN11020

CERTIFICATIONS :

# DN23163 Castro, Eileen

NPI: 1518348796 LIC: DN23163

CERTIFICATIONS :

# DN21994 Cortes Morales,

Guillermo

NPI: 1912359266 LIC: DN21994

CERTIFICATIONS :

# DN22100 Corugedo, Ada

NPI: 1568814747 LIC: DN22100

CERTIFICATIONS :

# DN18680 Cruz, Karen

NPI: 1952623993 LIC: DN18680

CERTIFICATIONS :

# DN22964 Delgado, Ivette

NPI: 1679097869 LIC: DN22964

CERTIFICATIONS :

# DN21977 Garrote, Rogelio

NPI: 1144671470 LIC: DN21977

CERTIFICATIONS :

# DN13322 Gomara, Luis

NPI: 1659381879 LIC: DN13322

CERTIFICATIONS :

# DN21830 Guerra-Crespa, Beatriz

NPI: 1376960658 LIC: DN21830

CERTIFICATIONS :

# DN21886 Martinez, Claudia

NPI: 1194175794 LIC: DN21886

CERTIFICATIONS :

# DN18073 Martinez, Miguel

NPI: 1043408271 LIC: DN18073

CERTIFICATIONS :

# DN22276 Pena-Marro, Blanca

NPI: 1043620099 LIC: DN22276

CERTIFICATIONS :

# DN21249 Prieto, Evelyn

NPI: 1598146755 LIC: DN21249

CERTIFICATIONS :

# DN21179 Reyes Canal, Osmil

NPI: 1356732275 LIC: DN21179

CERTIFICATIONS :

# DN13492 Salcines, Damaris

NPI: 1891705091 LIC: DN13492

CERTIFICATIONS :

# DN23323 Sanchez, Marlie

NPI: 1891287462 LIC: DN23323

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

# DN20482 Valdes, Martha

NPI: 1649605585 LIC: DN20482

CERTIFICATIONS :

#009424

Family and Cosmetic Dentistry

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 27 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 28: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

125 Ne 8Th St Ste 1

Homestead, FL 33030

(305) 245-6458

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN11020 Alfonzo, Fara

NPI: 1851447684 LIC: DN11020

CERTIFICATIONS :

# DN23163 Castro, Eileen

NPI: 1518348796 LIC: DN23163

CERTIFICATIONS :

# DN21994 Cortes Morales,

Guillermo

NPI: 1912359266 LIC: DN21994

CERTIFICATIONS :

# DN22100 Corugedo, Ada

NPI: 1568814747 LIC: DN22100

CERTIFICATIONS :

# DN18680 Cruz, Karen

NPI: 1952623993 LIC: DN18680

CERTIFICATIONS :

# DN22964 Delgado, Ivette

NPI: 1679097869 LIC: DN22964

CERTIFICATIONS :

# DN21977 Garrote, Rogelio

NPI: 1144671470 LIC: DN21977

CERTIFICATIONS :

# DN13322 Gomara, Luis

NPI: 1659381879 LIC: DN13322

CERTIFICATIONS :

# DN21830 Guerra-Crespa, Beatriz

NPI: 1376960658 LIC: DN21830

CERTIFICATIONS :

# DN21886 Martinez, Claudia

NPI: 1194175794 LIC: DN21886

CERTIFICATIONS :

# DN18073 Martinez, Miguel

NPI: 1043408271 LIC: DN18073

CERTIFICATIONS :

# DN22276 Pena-Marro, Blanca

NPI: 1043620099 LIC: DN22276

CERTIFICATIONS :

# DN21249 Prieto, Evelyn

NPI: 1598146755 LIC: DN21249

CERTIFICATIONS :

# DN21179 Reyes Canal, Osmil

NPI: 1356732275 LIC: DN21179

CERTIFICATIONS :

# DN13492 Salcines, Damaris

NPI: 1891705091 LIC: DN13492

CERTIFICATIONS :

# DN23323 Sanchez, Marlie

NPI: 1891287462 LIC: DN23323

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

# DN20482 Valdes, Martha

NPI: 1649605585 LIC: DN20482

CERTIFICATIONS :

#009425

Family and Cosmetic Dentistry

13706 Sw 56Th St Ste 201

Miami, FL 33175

www.familyplusdentalcenters.com

(305) 387-4954

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN11020 Alfonzo, Fara

NPI: 1851447684 LIC: DN11020

CERTIFICATIONS :

# DN23163 Castro, Eileen

NPI: 1518348796 LIC: DN23163

CERTIFICATIONS :

# DN21994 Cortes Morales,

Guillermo

NPI: 1912359266 LIC: DN21994

CERTIFICATIONS :

# DN22100 Corugedo, Ada

NPI: 1568814747 LIC: DN22100

CERTIFICATIONS :

# DN18680 Cruz, Karen

NPI: 1952623993 LIC: DN18680

CERTIFICATIONS :

# DN22964 Delgado, Ivette

NPI: 1679097869 LIC: DN22964

CERTIFICATIONS :

# DN21977 Garrote, Rogelio

NPI: 1144671470 LIC: DN21977

CERTIFICATIONS :

# DN13322 Gomara, Luis

NPI: 1659381879 LIC: DN13322

CERTIFICATIONS :

# DN21830 Guerra-Crespa, Beatriz

NPI: 1376960658 LIC: DN21830

CERTIFICATIONS :

# DN21886 Martinez, Claudia

NPI: 1194175794 LIC: DN21886

CERTIFICATIONS :

# DN18073 Martinez, Miguel

NPI: 1043408271 LIC: DN18073

CERTIFICATIONS :

# DN22276 Pena-Marro, Blanca

NPI: 1043620099 LIC: DN22276

CERTIFICATIONS :

# DN21249 Prieto, Evelyn

NPI: 1598146755 LIC: DN21249

CERTIFICATIONS :

# DN21179 Reyes Canal, Osmil

NPI: 1356732275 LIC: DN21179

CERTIFICATIONS :

# DN13492 Salcines, Damaris

NPI: 1891705091 LIC: DN13492

CERTIFICATIONS :

# DN23323 Sanchez, Marlie

NPI: 1891287462 LIC: DN23323

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

# DN20482 Valdes, Martha

NPI: 1649605585 LIC: DN20482

CERTIFICATIONS :

#009428

Family and Cosmetic Dentistry

2900 W. 12Th Ave Ste 27

Hialeah, FL 33012

(786) 800-0171

English, Spanish

M-T 11am-7pm

W 9am-6pm, Th 11am-7pm,F

9am-6pm

S 8am - 3pm

# DN11020 Alfonzo, Fara

NPI: 1851447684 LIC: DN11020

CERTIFICATIONS :

# DN23163 Castro, Eileen

NPI: 1518348796 LIC: DN23163

CERTIFICATIONS :

# DN21994 Cortes Morales,

Guillermo

NPI: 1912359266 LIC: DN21994

CERTIFICATIONS :

# DN22100 Corugedo, Ada

NPI: 1568814747 LIC: DN22100

CERTIFICATIONS :

# DN18680 Cruz, Karen

NPI: 1952623993 LIC: DN18680

CERTIFICATIONS :

# DN22964 Delgado, Ivette

NPI: 1679097869 LIC: DN22964

CERTIFICATIONS :

# DN21977 Garrote, Rogelio

NPI: 1144671470 LIC: DN21977

CERTIFICATIONS :

# DN13322 Gomara, Luis

NPI: 1659381879 LIC: DN13322

CERTIFICATIONS :

# DN21830 Guerra-Crespa, Beatriz

NPI: 1376960658 LIC: DN21830

CERTIFICATIONS :

# DN21886 Martinez, Claudia

NPI: 1194175794 LIC: DN21886

CERTIFICATIONS :

# DN18073 Martinez, Miguel

NPI: 1043408271 LIC: DN18073

CERTIFICATIONS :

# DN22276 Pena-Marro, Blanca

NPI: 1043620099 LIC: DN22276

CERTIFICATIONS :

# DN21249 Prieto, Evelyn

NPI: 1598146755 LIC: DN21249

CERTIFICATIONS :

# DN21179 Reyes Canal, Osmil

NPI: 1356732275 LIC: DN21179

CERTIFICATIONS :

# DN13492 Salcines, Damaris

NPI: 1891705091 LIC: DN13492

CERTIFICATIONS :

# DN23323 Sanchez, Marlie

NPI: 1891287462 LIC: DN23323

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

# DN20482 Valdes, Martha

NPI: 1649605585 LIC: DN20482

CERTIFICATIONS :

#022660

Family and Cosmetic Dentistry

432 Nw 12Th Ave

Miami, FL 33128

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 28 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 29: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(305) 387-4954

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 2pm

# DN23163 Castro, Eileen

NPI: 1518348796 LIC: DN23163

CERTIFICATIONS :

# DN21994 Cortes Morales,

Guillermo

NPI: 1912359266 LIC: DN21994

CERTIFICATIONS :

# DN22964 Delgado, Ivette

NPI: 1679097869 LIC: DN22964

CERTIFICATIONS :

# DN21579 Garcia, Idalmes

NPI: 1245675107 LIC: DN21579

CERTIFICATIONS :

# DN21977 Garrote, Rogelio

NPI: 1144671470 LIC: DN21977

CERTIFICATIONS :

# DN13322 Gomara, Luis

NPI: 1659381879 LIC: DN13322

CERTIFICATIONS :

# DN21886 Martinez, Claudia

NPI: 1194175794 LIC: DN21886

CERTIFICATIONS :

# DN21249 Prieto, Evelyn

NPI: 1598146755 LIC: DN21249

CERTIFICATIONS :

# DN21179 Reyes Canal, Osmil

NPI: 1356732275 LIC: DN21179

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

#022715

Family and Cosmetic Dentistry

1437 Nw 1St Terr

Homestead, FL 33030

(305) 387-4954

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN23163 Castro, Eileen

NPI: 1518348796 LIC: DN23163

CERTIFICATIONS :

# DN21994 Cortes Morales,

Guillermo

NPI: 1912359266 LIC: DN21994

CERTIFICATIONS :

# DN18680 Cruz, Karen

NPI: 1952623993 LIC: DN18680

CERTIFICATIONS :

# DN22964 Delgado, Ivette

NPI: 1679097869 LIC: DN22964

CERTIFICATIONS :

# DN21579 Garcia, Idalmes

NPI: 1245675107 LIC: DN21579

CERTIFICATIONS :

# DN21977 Garrote, Rogelio

NPI: 1144671470 LIC: DN21977

CERTIFICATIONS :

# DN13322 Gomara, Luis

NPI: 1659381879 LIC: DN13322

CERTIFICATIONS :

# DN21830 Guerra-Crespa, Beatriz

NPI: 1376960658 LIC: DN21830

CERTIFICATIONS :

# DN21886 Martinez, Claudia

NPI: 1194175794 LIC: DN21886

CERTIFICATIONS :

# DN22276 Pena-Marro, Blanca

NPI: 1043620099 LIC: DN22276

CERTIFICATIONS :

# DN21249 Prieto, Evelyn

NPI: 1598146755 LIC: DN21249

CERTIFICATIONS :

# DN21179 Reyes Canal, Osmil

NPI: 1356732275 LIC: DN21179

CERTIFICATIONS :

# DN23323 Sanchez, Marlie

NPI: 1891287462 LIC: DN23323

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

# DN20482 Valdes, Martha

NPI: 1649605585 LIC: DN20482

CERTIFICATIONS :

#022417

Family Dental Care

3934 Sw 8Th Street, Ste 208

Coral Gables, FL 33134

(305) 392-1958

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21526 Alvarez, Ariam

NPI: 1962841783 LIC: DN21526

CERTIFICATIONS :

#012059

Felicita Marquez Iglesias, DDS

4890 W. 3Rd Ave

Hialeah, FL 33012

(305) 826-0906

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 1pm

# DN20430 Marquez-Iglesias, Felicita

NPI: 1740619402 LIC: DN20430

CERTIFICATIONS :

#008287

Feoli Dental

1490 Ne Miami Garden Drive

Miami Gardens, FL 33179

www.feolidental.com

(305) 949-5252

English, Spanish, Creoles and Pidgins,

French-based(other)

M-T 9am-6pm

W-Th 9am-6pm

S 9am - 2pm

# DN18037 Feoli, Carmen

NPI: 1013199819 LIC: DN18037

CERTIFICATIONS :

# DN21293 Merikas, Amanda

NPI: 1669853305 LIC: DN21293

CERTIFICATIONS :

#013440

Flores Dental Group

11890 Sw 8Th Street, Ste #300

Miami, FL 33184

(305) 485-0072

English, Spanish

T 9am - 7pm

W-Th 9am-7pm

# DN117660 Flores, Joan

NPI: 1962604488 LIC: DN117660

CERTIFICATIONS :

• Inhalation Sedation

#FQHC022784

Floridental Clinic

9240 Sw 72Nd Street, Ste 115

Miami, FL 33173

(305) 595-0557

English, Spanish

T 9am - 6pm

W 9am-6pm,

# DN22851 Garcia, Lisset

NPI: 1487036216 LIC: DN22851

CERTIFICATIONS :

#016124

Gary Alvo DDS

16600 Ne 8Th Ave

Miami, FL 33162

(305) 944-3441

English, Farsi, Spanish

M-T 7am-3pm

S 8am - 2pm

# DN7805 Alvo, Gary

NPI: 1518997451 LIC: DN7805

CERTIFICATIONS :

#006638

Gateway Dental

2375 Sw 27Th Ave

Miami, FL 33145

www.gatewaydentalinc.com

(305) 856-2300

Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN18302 Herrera, Victoria

NPI: 1114185550 LIC: DN18302

CERTIFICATIONS :

# DN15212 Miranda, Pablo

NPI: 1023036365 LIC: DN15212

CERTIFICATIONS :

# DN15477 Perrotti, Steven

NPI: 1144249780 LIC: DN15477

CERTIFICATIONS :

# DN21226 Santana, David

NPI: 1700266657 LIC: DN21226

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

#010098

Gateway Dental

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 29 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 30: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

1050 Nw 14Th Street, 2Nd Floor, Ste

204

Miami, FL 33136

www.gatewaydentalinc.com

(305) 856-2300

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN18302 Herrera, Victoria

NPI: 1114185550 LIC: DN18302

CERTIFICATIONS :

# DN15212 Miranda, Pablo

NPI: 1023036365 LIC: DN15212

CERTIFICATIONS :

# DN15477 Perrotti, Steven

NPI: 1144249780 LIC: DN15477

CERTIFICATIONS :

# DN21226 Santana, David

NPI: 1700266657 LIC: DN21226

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

#017005

Gateway Dental

1400 Ne Miami Gardens Dr. Ste 201

North Miami Beach, FL 33179

(305) 856-2300

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN18302 Herrera, Victoria

NPI: 1114185550 LIC: DN18302

CERTIFICATIONS :

# DN15212 Miranda, Pablo

NPI: 1023036365 LIC: DN15212

CERTIFICATIONS :

# DN15477 Perrotti, Steven

NPI: 1144249780 LIC: DN15477

CERTIFICATIONS :

# DN21226 Santana, David

NPI: 1700266657 LIC: DN21226

CERTIFICATIONS :

# DN22991 Santiesteban, Aymara

NPI: 1265826168 LIC: DN22991

CERTIFICATIONS :

#022816

Gentle Teeth of Kendall

6670 Sw 117 Ave

Miami, FL 33183

(305) 595-3400

English, Spanish

M-T 8am-8pm

W-F 8am-8pm

S 8am - 8pm

# DN22652 Perez, Annabel

NPI: 1932639283 LIC: DN22652

CERTIFICATIONS :

#022744

Great Dental Expressions Inc

568 Hialeah Drive

Hialeah, FL 33010

(305) 835-0123

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 5pm

# DN22223 Fiffe, Eliseo

NPI: 1760737480 LIC: DN22223

CERTIFICATIONS :

#013364

Hammocks Dental Center, PA

9280 Hammock Blvd, Ste #102

Miami, FL 33196

(305) 387-5700

Spanish

M 12pm - 6pm, T 9am - 3pm

W 2pm-4pm, Th 12pm-6pm

S 10am - 1pm

# DN21526 Alvarez, Ariam

NPI: 1962841783 LIC: DN21526

CERTIFICATIONS :

# DN19377 Calderon, Erik

NPI: 1942596416 LIC: DN19377

CERTIFICATIONS :

• Inhalation Sedation

#011734

Happy Teeth Dental, LLC

7976 Sw 8Th St

Miami, FL 33144

(305) 266-4544

English, Spanish

M 2pm - 7pm, T 9am - 6pm

W 11am-6pm, Th 9am-6pm,F

9am-5pm

# DN16431 Rodriguez, Alejandro

NPI: 1942386305 LIC: DN16431

CERTIFICATIONS :

#012647

Health and Cosmetic Dental Care

4150 Nw 7Th St Ste 103

Miami, FL 33126

(305) 646-9222

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN19927 Rodriguez, Gretell

NPI: 1154678910 LIC: DN19927

CERTIFICATIONS :

#017698

Healthy Smile

9016 Nw 25Th St.

Miami, FL 33172

(786) 671-0174

English, Spanish

M-T 10am-6pm

W-F 10am-6pm

# DN16963 Figueredo, Maria

NPI: 1144313602 LIC: DN16963

CERTIFICATIONS :

#007623

Hialeah Dental Associates

2106 W. 68Th St

Hialeah, FL 33016

(305) 827-6661

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN13520 Mendez, Antonio

NPI: 1659570430 LIC: DN13520

CERTIFICATIONS :

# DN20271 Monzon, Lucrecia

NPI: 1477975399 LIC: DN20271

CERTIFICATIONS :

#013236

Hialeah Dental Care, Inc

4240 West 16Th Ave

Hialeah, FL 33012

(305) 823-1882

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21433 Iduate Banobre, Yolanda

NPI: 1598140618 LIC: DN21433

CERTIFICATIONS :

# DN17094 Rodriguez, Roxana

NPI: 1336263912 LIC: DN17094

CERTIFICATIONS :

# DN11884 Soler, Rosa

NPI: 1083738652 LIC: DN11884

CERTIFICATIONS :

#010839

Hialeah Dental Center

750 East 25Th Street

Hialeah, FL 33013

(305) 694-5400

English, Arabic, Chinese Mandarin,

Portuguese, Romanian, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN8062 Mulkay, Esteban

NPI: 1184784423 LIC: DN8062

CERTIFICATIONS :

# DN19606 Souza, Rodrigo

NPI: 1891958146 LIC: DN19606

CERTIFICATIONS :

#007981

Hialeah Dental Center, PA

1518 West 49Th Street

Hialeah, FL 33012

www.dentilife.com

(305) 823-2661

English, Spanish

M-T 12pm-8pm

W-Th 12pm-8pm

S 10am - 4pm

# DN19377 Calderon, Erik

NPI: 1942596416 LIC: DN19377

CERTIFICATIONS :

• Inhalation Sedation

# DN21495 Streett, Rosario

NPI: 1801230768 LIC: DN21495

CERTIFICATIONS :

#011423

Hialeah Miro Office Corp.

320 W 49 Street

Hialeah, FL 33012

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 30 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 31: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

www.mirodentalcenter.com

(305) 685-7494

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN11650 Miro, Claudio

NPI: 1417024118 LIC: DN11650

CERTIFICATIONS :

• Conscious Sedation

# DN16862 Trujillo, Alexander

NPI: 1043231996 LIC: DN16862

CERTIFICATIONS :

• Conscious Sedation

#013560

Homestead Family Dental Care

809 Ne 4Th Ave

Homestead, FL 33030

(305) 248-3961

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN19770 Hernandez, Daynet

NPI: 1336469121 LIC: DN19770

CERTIFICATIONS :

#012974

Honest Dental Service

400 Sw 27 Ave

Miami, FL 33135

(305) 456-8046

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN20070 Sepulveda, Isabel

NPI: 1790111763 LIC: DN20070

CERTIFICATIONS :

#010312

Hutchinson-Dental

100 Nw 170Th Street Ste 306

North Miami, FL 33169

(786) 235-5120

Creoles and Pidgins,

French-based(other), English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN19291 Hutchinson, Paula

NPI: 1801196936 LIC: DN19291

CERTIFICATIONS :

#008271

Idalmes Perez DDS, PA.

1141 Palm Ave

Hialeah, FL 33010

(305) 888-8555

English, Spanish

M-T 9am-6pm

Th-F 9am-6pm

# DN17928 Perez, Idalmes

NPI: 1881896306 LIC: DN17928

CERTIFICATIONS :

#009808

J.M. Dental Group Inc.

1470 Nw 107Th Ave, Ste F-G

Miami, FL 33172

(305) 594-8666

English, Spanish

M-T 9am-5pm

W 9am-6pm, Th 9am-5pm,F 9am-4pm

# DN20566 Del Castillo, Raymond

NPI: 1609212091 LIC: DN20566

CERTIFICATIONS :

# DN22217 Echeverri, Jonathan

NPI: 1104371137 LIC: DN22217

CERTIFICATIONS :

# DN14451 Hernandez, Norberto

NPI: 1285693267 LIC: DN14451

CERTIFICATIONS :

#008892

Jadent Inc.

3945 Sw 92 Ave

Miami, FL 33165

(305) 220-0066

Spanish

M-T 10am-7pm

W-F 10am-7pm

# DN14047 Arocha, Josefina

NPI: 1952448367 LIC: DN14047

CERTIFICATIONS :

# DN21384 Guevara, Anaely

NPI: 1184007932 LIC: DN21384

CERTIFICATIONS :

#016516

Jeps Dental Group LLC

19517 Nw 57Th Ave

Opa Locka, FL 33055

(305) 627-3402

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN15474 Perez-Solar, Juan

NPI: 1770658304 LIC: DN15474

CERTIFICATIONS :

#FQHC018872

Jessie Trice Community Health

Center, Inc

217 Nw 15Th Street

Miami, FL 33136

(305) 637-6400

Creoles and Pidgins,

English-based(other), English,

Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN11213 Barcia, Antonio

NPI: 1306052626 LIC: DN11213

CERTIFICATIONS :

# DN23140 Feiz, Maria

NPI: 1932615929 LIC: DN23140

CERTIFICATIONS :

# DN12903 George, Deborah

NPI: 1720149180 LIC: DN12903

CERTIFICATIONS :

# DN21713 Lebron, Vanessa

NPI: 1619336369 LIC: DN21713

CERTIFICATIONS :

# DN10368 Perdigon-Cangahuala,

Nitza

NPI: 1720006174 LIC: DN10368

CERTIFICATIONS :

• Inhalation Sedation

# DN19661 Williams, Tosha

NPI: 1609009463 LIC: DN19661

CERTIFICATIONS :

• Inhalation Sedation

#FQHC015997

Jessie Trice Community Health

Center, Inc.

901 E. 10Th Ave, Bay #39

Hialeah, FL 33010

(305) 637-6400

English, Spanish, Creoles and Pidgins,

French-based(other)

M 10am - 6pm,

# DN11213 Barcia, Antonio

NPI: 1306052626 LIC: DN11213

CERTIFICATIONS :

# DN23140 Feiz, Maria

NPI: 1932615929 LIC: DN23140

CERTIFICATIONS :

# DN12903 George, Deborah

NPI: 1720149180 LIC: DN12903

CERTIFICATIONS :

# DN21713 Lebron, Vanessa

NPI: 1619336369 LIC: DN21713

CERTIFICATIONS :

# DN10368 Perdigon-Cangahuala,

Nitza

NPI: 1720006174 LIC: DN10368

CERTIFICATIONS :

• Inhalation Sedation

# DN19661 Williams, Tosha

NPI: 1609009463 LIC: DN19661

CERTIFICATIONS :

• Inhalation Sedation

#FQHC016404

Jessie Trice Community Health

Center, Inc.

490 Opa-Locka Blvd

Opa Locka, FL 33054

(305) 637-6400

English

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-5pm

# DN11213 Barcia, Antonio

NPI: 1306052626 LIC: DN11213

CERTIFICATIONS :

# DN23140 Feiz, Maria

NPI: 1932615929 LIC: DN23140

CERTIFICATIONS :

# DN12903 George, Deborah

NPI: 1720149180 LIC: DN12903

CERTIFICATIONS :

# DN21713 Lebron, Vanessa

NPI: 1619336369 LIC: DN21713

CERTIFICATIONS :

# DN10368 Perdigon-Cangahuala,

Nitza

NPI: 1720006174 LIC: DN10368

CERTIFICATIONS :

• Inhalation Sedation

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 31 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 32: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN19661 Williams, Tosha

NPI: 1609009463 LIC: DN19661

CERTIFICATIONS :

• Inhalation Sedation

#FQHC9796

Jessie Trice Community Health

Center, Inc.

5361 N.W. 22Nd Ave

Miami, FL 33142

(305) 637-6400

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 8am-5pm

W-F 8am-5pm

# DN11213 Barcia, Antonio

NPI: 1306052626 LIC: DN11213

CERTIFICATIONS :

# DN23140 Feiz, Maria

NPI: 1932615929 LIC: DN23140

CERTIFICATIONS :

# DN12903 George, Deborah

NPI: 1720149180 LIC: DN12903

CERTIFICATIONS :

# DN21713 Lebron, Vanessa

NPI: 1619336369 LIC: DN21713

CERTIFICATIONS :

# DN10368 Perdigon-Cangahuala,

Nitza

NPI: 1720006174 LIC: DN10368

CERTIFICATIONS :

• Inhalation Sedation

# DN19661 Williams, Tosha

NPI: 1609009463 LIC: DN19661

CERTIFICATIONS :

• Inhalation Sedation

#FQHC9797

Jessie Trice Community Health

Center, Inc.

5607 Nw 27Th Ave, Ste 2

Miami, FL 33142

(305) 637-6400

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 7am-6pm

W-F 7am-6pm

# DN11213 Barcia, Antonio

NPI: 1306052626 LIC: DN11213

CERTIFICATIONS :

# DN23140 Feiz, Maria

NPI: 1932615929 LIC: DN23140

CERTIFICATIONS :

# DN12903 George, Deborah

NPI: 1720149180 LIC: DN12903

CERTIFICATIONS :

# DN21713 Lebron, Vanessa

NPI: 1619336369 LIC: DN21713

CERTIFICATIONS :

# DN10368 Perdigon-Cangahuala,

Nitza

NPI: 1720006174 LIC: DN10368

CERTIFICATIONS :

• Inhalation Sedation

# DN19661 Williams, Tosha

NPI: 1609009463 LIC: DN19661

CERTIFICATIONS :

• Inhalation Sedation

#FQHC9799

Jessie Trice Community Health

Center, Inc.

18360 N.W. 7Th Ave

Miami, FL 33169

(305) 637-6400

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 8am-5pm

W-F 8am-5pm

S 9am - 2pm

# DN11213 Barcia, Antonio

NPI: 1306052626 LIC: DN11213

CERTIFICATIONS :

# DN23140 Feiz, Maria

NPI: 1932615929 LIC: DN23140

CERTIFICATIONS :

# DN12903 George, Deborah

NPI: 1720149180 LIC: DN12903

CERTIFICATIONS :

# DN21713 Lebron, Vanessa

NPI: 1619336369 LIC: DN21713

CERTIFICATIONS :

# DN10368 Perdigon-Cangahuala,

Nitza

NPI: 1720006174 LIC: DN10368

CERTIFICATIONS :

• Inhalation Sedation

# DN19661 Williams, Tosha

NPI: 1609009463 LIC: DN19661

CERTIFICATIONS :

• Inhalation Sedation

#007902

Jose R. Geno, DMD

2200 Sw 16Th Street, Ste 202

Miami, FL 33145

(305) 854-8707

English, Spanish

M-T 9am-6pm

Th-F 9am-6pm

S 10am - 3pm

# DN10499 Geno, Jose

NPI: 1942496658 LIC: DN10499

CERTIFICATIONS :

#011384

Joseph S. Gay, D.D.S.

18063 Nw 27Th Ave

Miami Gardens, FL 33056

(305) 625-3747

English

M-T 9am-5pm

W 11am-7pm, Th 9am-12pm,F

7am-1pm

# DN5710 Gay, Joseph

NPI: 1114084639 LIC: DN5710

CERTIFICATIONS :

#011427

Jossue Alfonso DMD PA

351 Nw 42Nd Ave, Ste 402

Miami, FL 33126

(305) 642-4142

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN19316 Alfonso, Jossue

NPI: 1235423997 LIC: DN19316

CERTIFICATIONS :

#013606

JR Dental Office INC.

6847 W. 4Th Ave

Hialeah, FL 33014

(786) 431-5000

English, Spanish

T 9am - 6pm

W 10am-7pm, Th 9am-6pm,F

10am-7pm

# DN20920 De Quesada, Diana

NPI: 1992105688 LIC: DN20920

CERTIFICATIONS :

# DN12018 Marini, Nohelia

NPI: 1568640852 LIC: DN12018

CERTIFICATIONS :

#012608

Jubidental Services Corp

299 Alhambra Circle, Ste 202

Miami, FL 33134

(305) 444-3074

English, Spanish

M-T 11am-5pm

W-F 8am-3pm

# DN20131 Cotelo-Pardo, Yanepsi

NPI: 1881986891 LIC: DN20131

CERTIFICATIONS :

#019686

Kendall Dental & Implant Center

13055 Sw 42Nd St Ste #206

Miami, FL 33175

kendalldentalimplant.com

(305) 846-9669

English, Spanish

M-T 8am-5pm

W 8am-5pm, Th 8am-8pm,F 8am-5pm

S 9am - 2pm

# DN18984 Garcia, Delio

NPI: 1790006823 LIC: DN18984

CERTIFICATIONS :

#011104

Kendall Wood Park Dental Center

12001 Sw 128 Court, Ste 204

Miami, FL 33186

www.prodentalcenters.com

(305) 330-9261

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

S 9am - 1pm

# DN17100 Corrales-Iglesias, Luisa

NPI: 1861546277 LIC: DN17100

CERTIFICATIONS :

#018216

Kindly Dental

18652 Nw 67Th Ave, Ste 27

Hialeah, FL 33015

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 32 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 33: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

www.nsdclinic.com

(305) 474-0400

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

S 8am - 1pm

# DN20258 Garcia Lopez, Dorgis

NPI: 1992147326 LIC: DN20258

CERTIFICATIONS :

#017577

Latin Quarter Dental PA

1660 Sw 1St St

Miami, FL 33135

(305) 642-8499

English, Spanish

M-T 9am-2pm

W-F 9am-2pm

S 7am - 2pm

# DN19240 Lea Plaza, Rodolfo

NPI: 1932407103 LIC: DN19240

CERTIFICATIONS :

#012706

Lemus Dental Group

5171 Sw 8Th St

Miami, FL 33134

(305) 567-0236

English, Spanish

M 10am - 7pm, T 9am - 5pm

W 10am-7pm, Th 9am-5pm,F

10am-3pm

# DN20326 Lemus, Isel

NPI: 1033541537 LIC: DN20326

CERTIFICATIONS :

#007913

Liliana M. Angulo Dental Family

Practice, PA

614 E. 49Th Street

Hialeah, FL 33013

(305) 846-9126

Spanish

M 9am - 3pm, T 9am - 8pm

W 9am-3pm, Th 9am-8pm

S 9am - 3pm

# DN17639 Angulo, Liliana

NPI: 1841494648 LIC: DN17639

CERTIFICATIONS :

#008948

Lobaina Dental

8822 Sw 24Th St

Miami, FL 33165

lobainadental.com

(305) 480-9838

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN18774 Lobaina, Yoan

NPI: 1245468131 LIC: DN18774

CERTIFICATIONS :

# DN20781 Perez, Zaily

NPI: 1063828929 LIC: DN20781

CERTIFICATIONS :

#009614

Lobaina Dental

30 Nw 15 Street

Homestead, FL 33030

lobainadental.com

(305) 245-9691

English, Spanish

M-T 9am-4pm

W-F 9am-4pm

# DN18774 Lobaina, Yoan

NPI: 1245468131 LIC: DN18774

CERTIFICATIONS :

#012095

Luis M. Santamarina, D.M.D.

330 Sw 27Th Ave Ste 602

Miami, FL 33135

(305) 644-3464

Spanish, English, German

M 9am - 12pm, T 9am - 5pm

W-Th 9am-5pm

# DN8610 Santamarina, Luis

NPI: 1427157320 LIC: DN8610

CERTIFICATIONS :

#018466

Maira Morales DDS LLC

5232 W. Flagler St

Miami, FL 33134

(305) 442-0331

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN21552 Morales, Maira

NPI: 1023202496 LIC: DN21552

CERTIFICATIONS :

#008355

Manuel E. Costa, DDS

791 E. 48Th St

Hialeah, FL 33013

(305) 769-0252

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 12pm

# DN8736 Costa, Manuel

NPI: 1659495307 LIC: DN8736

CERTIFICATIONS :

#011394

Maria Hernandez, DDS

2500 Sw 107 Ave, Ste #45

Miami, FL 33165

(305) 223-5439

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN12595 Hernandez, Maria

NPI: 1902846967 LIC: DN12595

CERTIFICATIONS :

#018131

Med Dental Associates

7200 Nw 7Th St. #333

Miami, FL 33126

(305) 264-0063

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN20905 Rodriguez Castro, Miriam

NPI: 1992051700 LIC: DN20905

CERTIFICATIONS :

# DN17094 Rodriguez, Roxana

NPI: 1336263912 LIC: DN17094

CERTIFICATIONS :

#FQHC012099

Miami Beach Community Health

Center, Inc.

710 Alton Rd

Miami Beach, FL 33139

(305) 538-8835

English, Spanish

M 7am - 6pm, T 7am - 5pm

Th-F 7am-5pm

# DN15270 Amundaray, Juan

NPI: 1306218797 LIC: DN15270

CERTIFICATIONS :

# DN15859 Rodriguez, Hernan

NPI: 1003950502 LIC: DN15859

CERTIFICATIONS :

# DN23703 Tellez Armenteros, Ana

NPI: 1356828008 LIC: DN23703

CERTIFICATIONS :

#FQHC015504

Miami Beach Community Health

Center, Inc.

11645 Biscayne Blvd. Ste 401-403

North Miami, FL 33181

(305) 538-8835

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 7am-4pm

W-F 7am-4pm

# DN15270 Amundaray, Juan

NPI: 1306218797 LIC: DN15270

CERTIFICATIONS :

# DN15859 Rodriguez, Hernan

NPI: 1003950502 LIC: DN15859

CERTIFICATIONS :

# DN23703 Tellez Armenteros, Ana

NPI: 1356828008 LIC: DN23703

CERTIFICATIONS :

#006579

Miami International Mall Dental

1455 Nw 107Th Ave, Ste 584

Doral, FL 33172

(305) 597-8787

Russian, Spanish

M-T 10am-9pm

W-F 10am-9pm

S 9am - 9pm

# DN22246 Antezana, Mauricio

NPI: 1063876399 LIC: DN22246

CERTIFICATIONS :

# DN7894 Cullen, William

NPI: 1013110535 LIC: DN7894

CERTIFICATIONS :

• Inhalation Sedation

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN20945 Fornos, Jorge

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 33 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 34: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1831594415 LIC: DN20945

CERTIFICATIONS :

# DN14223 Gerry, Charlotte

NPI: 1770789455 LIC: DN14223

CERTIFICATIONS :

# DN20151 Gonzalez, Kenia

NPI: 1578902813 LIC: DN20151

CERTIFICATIONS :

# DN22451 Gruenberg, Alex

NPI: 1255844924 LIC: DN22451

CERTIFICATIONS :

# DN22242 Guerra, Vannette

NPI: 1598184327 LIC: DN22242

CERTIFICATIONS :

# DN23847 Khan, Adiba

NPI: 1649638172 LIC: DN23847

CERTIFICATIONS :

# DN23637 Lopez, Catherine

NPI: 1558841890 LIC: DN23637

CERTIFICATIONS :

# DN22702 Pham, Quynhnhu

NPI: 1609323948 LIC: DN22702

CERTIFICATIONS :

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

# DN23021 Riboul, Sandrine

NPI: 1609227057 LIC: DN23021

CERTIFICATIONS :

• Inhalation Sedation

# DN23007 Rivera, Lina

NPI: 1760908743 LIC: DN23007

CERTIFICATIONS :

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

# DN20475 Santiago, Germaine

NPI: 1922341460 LIC: DN20475

CERTIFICATIONS :

#CHC022739

Miami Lakes Cosmetic Dentistry

6600 Cow Pen Road

Hialeah, FL 33014

(305) 823-7521

English

M-T 9am-6pm

W 12pm-7pm, Th 9am-6pm,F

9am-2pm

# DN20996 Peralta, Johnny

NPI: 1396179701 LIC: DN20996

CERTIFICATIONS :

#021944

Migdalia I Seijas DDS, PA

1169 W. 35Th Street

Hialeah, FL 33012

(305) 819-0820

English, Spanish

M 11am - 6pm, T 10am - 6pm

W-Th 11am-6pm

# DN13282 Seijas, Migdalia

NPI: 1548677271 LIC: DN13282

CERTIFICATIONS :

#011422

Miro Kendall Dental Office

13550 Sw 88 St, Ste 100

Miami, FL 33186

(305) 273-4334

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN11650 Miro, Claudio*

NPI: 1417024118 LIC: DN11650

CERTIFICATIONS :

• Conscious Sedation

# DN16786 Miro, Kiara*

NPI: 1427078625 LIC: DN16786

CERTIFICATIONS :

#012860

MJ Dental Office

2360 W. 68Th St Ste 124

Hialeah, FL 33016

(305) 825-7447

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN21842 Alvarado, Yailen

NPI: 1700235363 LIC: DN21842

CERTIFICATIONS :

# D22548 Dopazo, Dhunia

NPI: 1467982629 LIC: D22548

CERTIFICATIONS :

# DN19789 Gil Araujo, Eduardo

NPI: 1841553112 LIC: DN19789

CERTIFICATIONS :

#021794

Molina Dental and Associates

7921 Bird Road, Ste 45

Miami, FL 33155

(305) 262-1077M-T 8am-6pm

W-F 8am-6pm

S 9am - 2pm

# DN21386 Molina Ariza, Yudisbel

NPI: 1760865067 LIC: DN21386

CERTIFICATIONS :

#016236

Morell Dental Care

3750 W. 16 Ave Ste 236-U

Hialeah, FL 33012

www.morelldental.com

(305) 231-0545

English, Spanish

M-T 10am-6pm

W-F 10am-6pm

# DN17626 Morell, Nayade

NPI: 1942396502 LIC: DN17626

CERTIFICATIONS :

#013978

My Smile Center

12800 Sw 8Th St

Miami, FL 33184

(786) 332-3176

English, Spanish

M 10am - 6pm,

W 9am-6pm, Th 10am-6pm,F

9am-4pm

S 9am - 3pm

# DN21526 Alvarez, Ariam

NPI: 1962841783 LIC: DN21526

CERTIFICATIONS :

# DN13222 Friedman, Rene

NPI: 1689890436 LIC: DN13222

CERTIFICATIONS :

#017854

Naranja Family Dentistry PA

27325 S. Dixie Hwy

Homestead, FL 33032

(786) 601-2644

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 2pm

# DN19240 Lea Plaza, Rodolfo

NPI: 1932407103 LIC: DN19240

CERTIFICATIONS :

#FQHC7695

Naranja Health Center

13805 Sw 264Th Street

Homestead, FL 33032

www.chisouthfl.org

(305) 258-8066

English, Chinese Mandarin, Creoles

and Pidgins, English-based(other),

French, Polish, Spanish

Th-F 8am-6pm

S 8am - 12pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#011548

New Dental Care Corp

1251 Nw 36 Street Ste A

Miami, FL 33142

(305) 649-9443

English, Spanish

M 8am - 5pm, T 9am - 6pm

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 34 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 35: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

W 9am-6pm, Th 8am-5pm,F 9am-4pm

# DN11884 Soler, Rosa

NPI: 1083738652 LIC: DN11884

CERTIFICATIONS :

# DN23694 Yglesias Ruiz, Erick

NPI: 1427534239 LIC: DN23694

CERTIFICATIONS :

• Inhalation Sedation

#013438

New Family Dentistry

1410 W. 68Th St

Hialeah, FL 33014

(305) 557-6968

English, Spanish

M-T 9am-8pm

W-Th 9am-8pm

# DN12604 Mendigutia, Jose

NPI: 1396876991 LIC: DN12604

CERTIFICATIONS :

#009811

Norberto J. Hernandez D.D.S.,

P.A.

1235 Sw 27Th Ave

Miami, FL 33135

(305) 642-7796

English, Spanish

M-T 10am-5pm

W-F 10am-5pm

# DN14451 Hernandez, Norberto

NPI: 1285693267 LIC: DN14451

CERTIFICATIONS :

#010340

NSU- College of Dental Medicine -

NMB

1750 Ne 167Th St

North Miami Beach, FL 33162

(954) 262-1660

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DTP546 Bezerra, Anthony

NPI: 1972800852 LIC: DTP546

CERTIFICATIONS :

# DTP593 Block, Robert

NPI: 1245362516 LIC: DTP593

CERTIFICATIONS :

# DN13419 Ede-Nichols, Diane

NPI: 1225145683 LIC: DN13419

CERTIFICATIONS :

# DN22197 Khatib, Adel

NPI: 1235582503 LIC: DN22197

CERTIFICATIONS :

# DN23890 Robinson, Christina

NPI: 1386023810 LIC: DN23890

CERTIFICATIONS :

#014842

Oceandents Inc.

8216 W Flagler St

Miami, FL 33144

(786) 615-8586

English, Spanish

T 9am - 6pm

W-F 9am-6pm

# DN20900 Fernandez Dominguez,

Giselle

NPI: 1235484890 LIC: DN20900

CERTIFICATIONS :

#013413

Omar Perez-Murguia, DDS, PA

9835 Sw 40Th Street

Miami, FL 33165

(305) 552-6446

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN15727 Perez-Murguia, Omar

NPI: 1033210216 LIC: DN15727

CERTIFICATIONS :

#021740

Ortholine Family Dentistry

3934 Sw 8Th Street, Ste 305

Coral Gables, FL 33134

(305) 967-8882

English, Spanish

M 10am - 5pm,

W 10am-5pm,

# DN12529 Martinez, Jose

NPI: 1780798926 LIC: DN12529

CERTIFICATIONS :

#019161

Palmetto Dental Studio, Inc.

7306 W 20 Ave

Hialeah, FL 33016

www.thepalmettodentalstudio.com

(786) 747-4763

English, Spanish

M 8am - 5pm, T 8am - 7pm

W 8am-5pm, Th 8am-7pm,F 8am-5pm

S 9am - 3pm

# DN22568 Benavides, Alina

NPI: 1629507470 LIC: DN22568

CERTIFICATIONS :

#014229

Pan American Dental P.A. &

Assoc.

2060 Sw 27Th Ave

Miami, FL 33145

(305) 444-4430

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 1pm

# DN20998 Gutierrez, Marlen

NPI: 1740686948 LIC: DN20998

CERTIFICATIONS :

#014230

Pan American Dental P.A. &

Assoc.

1124 W. 29Th St

Hialeah, FL 33012

(305) 885-7767

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN20998 Gutierrez, Marlen

NPI: 1740686948 LIC: DN20998

CERTIFICATIONS :

#018945

Paya Dental and Associates

2143 Nw 7Th Street

Miami, FL 33125

(305) 541-5103

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 3pm

# DN21221 Paya, Anabel

NPI: 1609256700 LIC: DN21221

CERTIFICATIONS :

#008306

Pedro Alvarez DDS and Associates,

PA

610 E. 4Th Ave

Hialeah, FL 33010

(305) 885-5026

English, Spanish

M-T 1pm-6pm

W-Th 1pm-6pm

# DN11762 Alvarez, Pedro

NPI: 1235271255 LIC: DN11762

CERTIFICATIONS :

#018202

Pedro Quesada DDS PA

742 W. 49Th St

Hialeah, FL 33012

(786) 534-9216

English, Spanish

M 9am - 6pm, T 11am - 7pm

W 9am-6pm, Th 11am-7pm,F

9am-6pm

# DN21528 Quezada, Pedro

NPI: 1164898177 LIC: DN21528

CERTIFICATIONS :

#010480

Peggy Alvarez-Penabad

4651 Ponce De Leon Blvd, Ste 101

Coral Gables, FL 33146

(305) 548-8690

English, Spanish

M 9am - 5pm, T 9am - 1pm

W 9am-5pm, Th 9am-1pm,F 9am-5pm

S 9am - 12pm

# DN20378 Alvarez-Penabad, Peggy

NPI: 1205260601 LIC: DN20378

CERTIFICATIONS :

#021744

Perez Dental Group Inc

7801 Coral Way, Ste 122

Miami, FL 33155

(786) 360-3694

English, Spanish

M-T 12pm-9pm

W-F 12pm-9pm

# DN21498 Perez Carmona, Alba

NPI: 1548636244 LIC: DN21498

CERTIFICATIONS :

#015911

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 35 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 36: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Perkadent

1878 Sw 57Th Ave

Miami, FL 33155

(305) 262-9299

English, Spanish

M 8am - 3pm, T 9am - 5pm

W-F 9am-5pm

S 8am - 2pm

# DN20428 Revoredo, Karim

NPI: 1366730384 LIC: DN20428

CERTIFICATIONS :

#018714

Pro Dental Center West Hialeah

400 West 65 Street

Hialeah, FL 33012

(305) 827-0434

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN17100 Corrales-Iglesias, Luisa

NPI: 1861546277 LIC: DN17100

CERTIFICATIONS :

#008238

Professional Dental Group, PA

10122 West Flagler Street

Miami, FL 33174

(305) 226-3386

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN14823 Baro, Rosemarie

NPI: 1396758165 LIC: DN14823

CERTIFICATIONS :

#017415

Quality Professional Dentistry

Corp

5040 Nw 7Th St Ste 632

Miami, FL 33126

www.qualitydentatist Miami.com

(305) 342-2020

English, Spanish

M-T 10am-6pm

W-F 10am-6pm

S 10am - 5pm

# DN11609 Herdocia, Filiberto

NPI: 1750788030 LIC: DN11609

CERTIFICATIONS :

#009717

Ramos Dental Associates

4564 West 12Th Ave

Hialeah, FL 33012

(305) 558-2446

English, Spanish

M-T 10am-6pm

W-F 10am-6pm

# DN17350 Ramos, Luis

NPI: 1114000304 LIC: DN17350

CERTIFICATIONS :

#017261

Renata Kleiner-Pastoriza DDS PA

9654 Sw 72 St

Miami, FL 33173

(305) 598-3704

English, Spanish, Polish

M 10am - 6pm, T 9am - 6pm

W 9am-6pm, Th 9am-5pm,F 9am-2pm

# DN10551 Kleiner, Renata

NPI: 1700902400 LIC: DN10551

CERTIFICATIONS :

• Inhalation Sedation

#016138

Right Care Dental

8290 Bird Road, Ste 100

Miami, FL 33155

(786) 206-6021

English, Spanish

T 9am - 6pm

Th-F 9am-6pm

S 9am - 2pm

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

#022434

Right Care Dental LLC

1490 W. 49Th Place, Ste 220

Hialeah, FL 33012

(305) 456-1927M-T 9am-6pm

W-F 9am-6pm

S 9am - 2pm

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

#007730

Rosario Molina, DMD

4835 East 4Th Ave, Ste # A

Hialeah, FL 33013

(305) 685-5133

English, Spanish

W 9am-6pm,

# DN9515 Molina, Rosario

NPI: 1912231549 LIC: DN9515

CERTIFICATIONS :

#008237

Rosemarie Baro, DDS

1449 West Flagler Street

Miami, FL 33135

(305) 649-3500

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN14823 Baro, Rosemarie

NPI: 1396758165 LIC: DN14823

CERTIFICATIONS :

#022337

Ruiz Family Dentistry

10550 Nw 77 Court, Ste 220

Hialeah, FL 33016

(786) 401-7566

English, Spanish

M 10am - 7pm, T 11am - 7pm

W-Th 10am-7pm

S 10am - 2pm

# DN22962 Ruiz Rodriguez, Julian

NPI: 1447619820 LIC: DN22962

CERTIFICATIONS :

#011966

Salazar Dental

8346 Sw 8 St

Miami, FL 33144

(305) 269-0208

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN18913 Salazar, Manuel

NPI: 1699097261 LIC: DN18913

CERTIFICATIONS :

#012093

Salvador Rosales DDS P.A.

8150 Sw 8Th St Ste 206

Miami, FL 33144

(305) 261-5556

English, Spanish

M-T 9am-6pm

Th-F 9am-6pm

# DN12058 Rosales, Salvador

NPI: 1457441511 LIC: DN12058

CERTIFICATIONS :

#009227

Sandy Dental, Inc

8000 W. Flagler St. Ste 204

Miami, FL 33144

www.sanderdental.net

(305) 266-5222

Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN15375 Borges, Jorge

NPI: 1144361916 LIC: DN15375

CERTIFICATIONS :

• Inhalation Sedation

#014843

Simple Smiles LLC

18400 Nw 75Th Place, Ste 121

Miami, FL 33015

(305) 381-5412

English, Spanish

M 9am - 7pm, T 9am - 5pm

Th-F 9am-5pm

S 9am - 12pm

# DN17310 Lleo, Pedro

NPI: 1942306394 LIC: DN17310

CERTIFICATIONS :

#013979

Smile Design

2915 Nw 7Th St

Miami, FL 33125

(305) 846-9082

English, Spanish

M 8am - 4pm, T 11am - 7pm

Th-F 8am-4pm

# DN19487 Perez, Diley

NPI: 1780962092 LIC: DN19487

CERTIFICATIONS :

#006611

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 36 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 37: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Smile Perfect Dental Health

Center

580 E. 49Th Street

Hialeah, FL 33013

(305) 557-6711

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN13355 Cardenas, Elio

NPI: 1134287659 LIC: DN13355

CERTIFICATIONS :

#016312

Smile Perfect Dental Health

Center II

1075 E. 4Th Ave

Hialeah, FL 33010

(305) 557-6712

English, Spanish

M-T 9am-7pm

W-F 9am-7pm

# DN13355 Cardenas, Elio

NPI: 1134287659 LIC: DN13355

CERTIFICATIONS :

#FQHC7693

South Dade Health Center

13600 Sw 312Th Street

Homestead, FL 33033

(305) 242-6069

English, Chinese Mandarin, Creoles

and Pidgins, English-based(other),

French, Polish, Spanish

T 8am - 6pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#021604

South Dental at Forest

Lakes-Kendall Square Inc

16705 Sw 95Th Street

Miami, FL 33196

www.southdental.org

(786) 329-5909

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN14672 Tobon-Angel, Elias

NPI: 1689794885 LIC: DN14672

CERTIFICATIONS :

#019580

South Dixie Dental LLC

12531 South Dixie Hwy

Miami, FL 33156

(786) 842-3132

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN13836 Gonzalez, Maria

NPI: 1518244862 LIC: DN13836

CERTIFICATIONS :

#009753

Southland Mall Dental

20505 S. Dixie Hwy Ste 1683

Miami, FL 33189

(305) 232-3737

English, Spanish

M-T 10am-9pm

W-F 10am-9pm

S-Su 10am-6pm

# DN22246 Antezana, Mauricio

NPI: 1063876399 LIC: DN22246

CERTIFICATIONS :

# DN7894 Cullen, William

NPI: 1013110535 LIC: DN7894

CERTIFICATIONS :

• Inhalation Sedation

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN22796 Gandhi, Poorvi

NPI: 1548631229 LIC: DN22796

CERTIFICATIONS :

# DN22451 Gruenberg, Alex

NPI: 1255844924 LIC: DN22451

CERTIFICATIONS :

# DN22242 Guerra, Vannette

NPI: 1598184327 LIC: DN22242

CERTIFICATIONS :

# DN23847 Khan, Adiba

NPI: 1649638172 LIC: DN23847

CERTIFICATIONS :

# DN23637 Lopez, Catherine

NPI: 1558841890 LIC: DN23637

CERTIFICATIONS :

# DN22713 Morell, Omar

NPI: 1659801587 LIC: DN22713

CERTIFICATIONS :

# DN22702 Pham, Quynhnhu

NPI: 1609323948 LIC: DN22702

CERTIFICATIONS :

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

# DN23021 Riboul, Sandrine

NPI: 1609227057 LIC: DN23021

CERTIFICATIONS :

• Inhalation Sedation

# DN23007 Rivera, Lina

NPI: 1760908743 LIC: DN23007

CERTIFICATIONS :

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

# DN20475 Santiago, Germaine

NPI: 1922341460 LIC: DN20475

CERTIFICATIONS :

#016689

Stomatcare

15516 Sw 88Th Street

Miami, FL 33196

(305) 330-6359

English, Russian, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN10511 Green, George

NPI: 1609094580 LIC: DN10511

CERTIFICATIONS :

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

# DN22713 Morell, Omar

NPI: 1659801587 LIC: DN22713

CERTIFICATIONS :

# DN22695 Toribio Fabelo, Leydy

NPI: 1033639554 LIC: DN22695

CERTIFICATIONS :

• Inhalation Sedation

# DN18770 Trujillo, Madelene

NPI: 1881835767 LIC: DN18770

CERTIFICATIONS :

#016775

Stomatcare

1602 Ne 163Rd St.

North Miami Beach, FL 33162

(305) 330-6382

English, Russian, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN10511 Green, George

NPI: 1609094580 LIC: DN10511

CERTIFICATIONS :

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

# DN22713 Morell, Omar

NPI: 1659801587 LIC: DN22713

CERTIFICATIONS :

# DN22695 Toribio Fabelo, Leydy

NPI: 1033639554 LIC: DN22695

CERTIFICATIONS :

• Inhalation Sedation

# DN18770 Trujillo, Madelene

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 37 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 38: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1881835767 LIC: DN18770

CERTIFICATIONS :

#016776

Stomatcare

522 E. 25Th St

Hialeah, FL 33013

(305) 330-6351

English, Russian, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN10511 Green, George

NPI: 1609094580 LIC: DN10511

CERTIFICATIONS :

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

# DN22713 Morell, Omar

NPI: 1659801587 LIC: DN22713

CERTIFICATIONS :

# DN22695 Toribio Fabelo, Leydy

NPI: 1033639554 LIC: DN22695

CERTIFICATIONS :

• Inhalation Sedation

# DN18770 Trujillo, Madelene

NPI: 1881835767 LIC: DN18770

CERTIFICATIONS :

#018551

Stomatcare

10457 Sw 40Th St

Miami, FL 33165

(305) 602-1638

English, Russian, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN10511 Green, George

NPI: 1609094580 LIC: DN10511

CERTIFICATIONS :

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

# DN22713 Morell, Omar

NPI: 1659801587 LIC: DN22713

CERTIFICATIONS :

# DN18770 Trujillo, Madelene

NPI: 1881835767 LIC: DN18770

CERTIFICATIONS :

#007978

Sunshine Dental Center

4800 Nw 7Th Ave

Miami, FL 33127

(305) 756-3393

Spanish

M 10am - 5pm, T 11am - 6pm

W 10am-5pm, Th 10am-3pm,F

11am-5pm

# DN12108 Menendez, Alexander

NPI: 1467722546 LIC: DN12108

CERTIFICATIONS :

#018201

Superior Dental

148 Hialeah Drive

Hialeah, FL 33010

www.superiordentaldds.com

(786) 360-6262

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 1pm

# DN12018 Marini, Nohelia

NPI: 1568640852 LIC: DN12018

CERTIFICATIONS :

#008295

Susana Lizaso, DDS

4999 West 8Th Ave, Ste 28

Hialeah, FL 33012

(305) 556-6055

English, Spanish

M 9am - 5pm, T 10am - 6pm

W-Th 9am-5pm

# DN14242 Lizaso, Susana

NPI: 1174602429 LIC: DN14242

CERTIFICATIONS :

#022225

Sweet Smile Dental

16010 Nw 57Th Ave, Ste 130

Miami Lakes, FL 33014

(786) 536-9411

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN17960 Gonzalez, Susana

NPI: 1457654824 LIC: DN17960

CERTIFICATIONS :

#013762

Sylvia Santana P.A.

11300 Nw 87Th Ct # 166

Hialeah, FL 33018

www.biltmoredental.com

(305) 364-9322

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN19864 Santana-Mentrasti, Sylvia

NPI: 1679820344 LIC: DN19864

CERTIFICATIONS :

#008296

The Family Dental Care Center

646 W Palm Dr, Ste 200

Florida City, FL 33034

(305) 242-1200

English

M-T 9am-5pm

W-Th 9am-5pm

# DN14560 De la Cruz, Alejandro

NPI: 1013152016 LIC: DN14560

CERTIFICATIONS :

#021453

The Tooth Place

8 Palms Plz

Homestead, FL 33030

(305) 245-7974

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

S 9am - 4pm

# DN13216 Alvarado, Adolfo

NPI: 1881782993 LIC: DN13216

CERTIFICATIONS :

#011963

Thomas Dental Associates

14050 Nw 7Th Ave

Miami, FL 33168

(305) 688-7989

Spanish, English, Creoles and Pidgins,

English-based(other), Haitian; Haitian

Creole

M-T 12pm-6pm

W-Th 12pm-6pm

# DN9652 Krakauer, Thomas

NPI: 1093841009 LIC: DN9652

CERTIFICATIONS :

#008256

Tin Wai Hui

16209 Ne 13Th Ave

North Miami Beach, FL 33162

(305) 940-9888

English, Spanish, Mandarin

M-T 9am-6pm

W-F 9am-6pm

S 9am - 3pm

# DN12723 Hui, Tin

NPI: 1952408619 LIC: DN12723

CERTIFICATIONS :

# DN20869 Kiani, Kamran

NPI: 1699175729 LIC: DN20869

CERTIFICATIONS :

#008258

Tin Wai Hui, DMD, PA

12651 S. Dixie Hwy, #400

Miami, FL 33156

(305) 595-4548

English, Spanish, Cantonese, French,

Mandarin

M 9am - 5pm, T 10am - 6pm

Th-F 10am-6pm

S 9am - 2pm

# DN12723 Hui, Tin

NPI: 1952408619 LIC: DN12723

CERTIFICATIONS :

#018214

Traviesas Dental Care

4301 Palm Ave, Ste F

Hialeah, FL 33012

(305) 826-8980

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN22857 Traviesas Herrera, Eladio

NPI: 1992187876 LIC: DN22857

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 38 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 39: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#021734

Traviesas Dental Care

7933 Nw 2Nd Street

Miami, FL 33126

(305) 261-5251

English, Spanish

M 9am - 6pm,

W-Th 9am-6pm

S 8am - 2pm

# DN22857 Traviesas Herrera, Eladio

NPI: 1992187876 LIC: DN22857

CERTIFICATIONS :

#007535

Unlimited Dental Care

11498 Quail Roost Drive

Miami, FL 33157

(305) 232-4469

English, Spanish

M-T 9am-5pm

W 9am-6pm, Th 9am-5pm,F 9am-4pm

S 8am - 2pm

# DN18983 Batista, Virginia

NPI: 1760702575 LIC: DN18983

CERTIFICATIONS :

# DN16616 Villar, Tania

NPI: 1245320068 LIC: DN16616

CERTIFICATIONS :

#019072

Vassallo Dental Office P.A

8782 Sw 8Th St. Ste A

Miami, FL 33174

(305) 552-5340

English, Spanish

M-T 10am-6pm

W-Th 10am-6pm

# DN11722 Vasallo, Francisco

NPI: 1730207077 LIC: DN11722

CERTIFICATIONS :

#011679

Verrett Dental Center

3058 Nw 79 St

Miami, FL 33147

(305) 696-9999

English, Spanish

T 10am - 4pm

W-Th 10am-4pm

# DN18479 Hasan-Verrett, Hajar

NPI: 1386894715 LIC: DN18479

CERTIFICATIONS :

#FQHC7696

West Perrine Health Center

18255 Homestead Ave

Miami, FL 33157

(305) 234-7676

English, Chinese Mandarin, Creoles

and Pidgins, English-based(other),

French, Polish, Spanish

M 10am - 7pm, T 8am - 5pm

Th-F 8am-5pm

# DN19206 Campbell, Lisa

NPI: 1659594497 LIC: DN19206

CERTIFICATIONS :

# DN11945 Chin- Thompson, Angella

NPI: 1215150909 LIC: DN11945

CERTIFICATIONS :

# DN23756 Fernandez, Malena

NPI: 1740756063 LIC: DN23756

CERTIFICATIONS :

# DN10538 Johnson, Robert

NPI: 1275600686 LIC: DN10538

CERTIFICATIONS :

# DN11108 Lang, Tomas

NPI: 1386758886 LIC: DN11108

CERTIFICATIONS :

# DN17815 Lopez De Victoria,

Millied

NPI: 1467405423 LIC: DN17815

CERTIFICATIONS :

# DN13131 Miranda, Alejandra

NPI: 1558328823 LIC: DN13131

CERTIFICATIONS :

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

# DN14396 Watson-Hamilton, Sheri

NPI: 1053580639 LIC: DN14396

CERTIFICATIONS :

#006580

Westland Mall Dental

1665 W. 49Th St, Ste 1484

Hialeah, FL 33012

(305) 828-7779

Russian, Spanish

M-T 10am-9pm

W-F 10am-9pm

S-Su 10am-6pm

# DN22246 Antezana, Mauricio

NPI: 1063876399 LIC: DN22246

CERTIFICATIONS :

# DN7894 Cullen, William

NPI: 1013110535 LIC: DN7894

CERTIFICATIONS :

• Inhalation Sedation

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN22796 Gandhi, Poorvi

NPI: 1548631229 LIC: DN22796

CERTIFICATIONS :

# DN22451 Gruenberg, Alex

NPI: 1255844924 LIC: DN22451

CERTIFICATIONS :

# DN22242 Guerra, Vannette

NPI: 1598184327 LIC: DN22242

CERTIFICATIONS :

# DN23847 Khan, Adiba

NPI: 1649638172 LIC: DN23847

CERTIFICATIONS :

# DN23637 Lopez, Catherine

NPI: 1558841890 LIC: DN23637

CERTIFICATIONS :

# DN22702 Pham, Quynhnhu

NPI: 1609323948 LIC: DN22702

CERTIFICATIONS :

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

# DN23021 Riboul, Sandrine

NPI: 1609227057 LIC: DN23021

CERTIFICATIONS :

• Inhalation Sedation

# DN23007 Rivera, Lina

NPI: 1760908743 LIC: DN23007

CERTIFICATIONS :

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

# DN20475 Santiago, Germaine

NPI: 1922341460 LIC: DN20475

CERTIFICATIONS :

#009582

World Dental Care

1370 East 4 Ave

Hialeah, FL 33010

(305) 888-1458

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN22851 Garcia, Lisset

NPI: 1487036216 LIC: DN22851

CERTIFICATIONS :

# DN11884 Soler, Rosa

NPI: 1083738652 LIC: DN11884

CERTIFICATIONS :

#016311

Yudisbel Molina Ariza

8500 W Flagler St Ste 104A

Miami, FL 33144

www.yudisbelmolinadmd.com

(305) 226-0803

English, Spanish

M-T 9am-6pm

W-Th 9am-6pm

# DN21386 Molina Ariza, Yudisbel

NPI: 1760865067 LIC: DN21386

CERTIFICATIONS :

#008225

Zoraida T. Sanchez

1619 North East 8 Street

Homestead, FL 33030

(305) 247-9292

English, Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN16063 Sanchez, Zoradia

NPI: 1093824096 LIC: DN16063

CERTIFICATIONS :

#012554

Zuzel Trujillo, DMD, PA

13323 Sw 42Nd St

Miami, FL 33175

(305) 223-2828

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN18673 Trujillo, Zuzel

NPI: 1285860353 LIC: DN18673

CERTIFICATIONS :

ENDODONTICS

#FQHC018872

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 39 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 40: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Jessie Trice Community Health

Center, Inc

217 Nw 15Th Street

Miami, FL 33136

(305) 637-6400

Creoles and Pidgins,

English-based(other), English,

Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN14544 Cerrud, Clinio

NPI: 1629184676 LIC: DN14544

CERTIFICATIONS :

• Inhalation Sedation

#FQHC015997

Jessie Trice Community Health

Center, Inc.

901 E. 10Th Ave, Bay #39

Hialeah, FL 33010

(305) 637-6400

English, Spanish, Creoles and Pidgins,

French-based(other)

M 10am - 6pm,

# DN14544 Cerrud, Clinio

NPI: 1629184676 LIC: DN14544

CERTIFICATIONS :

• Inhalation Sedation

#FQHC016404

Jessie Trice Community Health

Center, Inc.

490 Opa-Locka Blvd

Opa Locka, FL 33054

(305) 637-6400

English

M-T 8am-5pm

W 8am-5pm, Th 8am-6pm,F 8am-5pm

# DN14544 Cerrud, Clinio

NPI: 1629184676 LIC: DN14544

CERTIFICATIONS :

• Inhalation Sedation

#FQHC9796

Jessie Trice Community Health

Center, Inc.

5361 N.W. 22Nd Ave

Miami, FL 33142

(305) 637-6400

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 8am-5pm

W-F 8am-5pm

# DN14544 Cerrud, Clinio

NPI: 1629184676 LIC: DN14544

CERTIFICATIONS :

• Inhalation Sedation

#FQHC9797

Jessie Trice Community Health

Center, Inc.

5607 Nw 27Th Ave, Ste 2

Miami, FL 33142

(305) 637-6400

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 7am-6pm

W-F 7am-6pm

# DN14544 Cerrud, Clinio

NPI: 1629184676 LIC: DN14544

CERTIFICATIONS :

• Inhalation Sedation

#FQHC9799

Jessie Trice Community Health

Center, Inc.

18360 N.W. 7Th Ave

Miami, FL 33169

(305) 637-6400

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 8am-5pm

W-F 8am-5pm

S 9am - 2pm

# DN14544 Cerrud, Clinio

NPI: 1629184676 LIC: DN14544

CERTIFICATIONS :

• Inhalation Sedation

#010340

NSU- College of Dental Medicine -

NMB

1750 Ne 167Th St

North Miami Beach, FL 33162

(954) 262-1660

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN9429 Flax, Michael

NPI: 1164583985 LIC: DN9429

CERTIFICATIONS :

# DN18606 Manjarres, Vivian

NPI: 1073747333 LIC: DN18606

CERTIFICATIONS :

# DN17496 Seltzer, Robert

NPI: 1619082120 LIC: DN17496

CERTIFICATIONS :

# DN14230 Zeim, Jason

NPI: 1760498422 LIC: DN14230

CERTIFICATIONS :

ORAL SURGEON

#021756

Ambiance Surgical Arts Center

8501 Sw 124Th Ave, Ste 208

Miami, FL 33183

(786) 377-4344

English, Spanish

M-T 7am-4pm

W 7am-4pm, Th 9am-6pm,F 7am-4pm

# DN21773 Hines, Jerri

NPI: 1861552770 LIC: DN21773

CERTIFICATIONS :

• General Anesthesia

MONROE COUNTY

DENTIST

#FQHC7692

Marathon Health Center

2855 Overseas Highway

Marathon, FL 33050

www.chisouthfl.org

(305) 743-4000

English, Chinese Mandarin, Creoles

and Pidgins, English-based(other),

French, Polish, Spanish

T 8am - 7pm

W 8am-5pm, Th 8am-7pm,F 8am-5pm

S 10am - 2pm

# DN20570 Rameau, Rejane

NPI: 1659541175 LIC: DN20570

CERTIFICATIONS :

#FQHC011413

RHN Dental Group - Key West

3706 N. Roosevelt Blvd, Ste E

Key West, FL 33040

(305) 517-6613

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN10562 Llodra, Clara

NPI: 1205816154 LIC: DN10562

CERTIFICATIONS :

# DN23214 Rodriguez Ramos, Oscar

NPI: 1831406982 LIC: DN23214

CERTIFICATIONS :

# DN17019 Sander, Michael

NPI: 1558878744 LIC: DN17019

CERTIFICATIONS :

NASSAU COUNTY

DENTIST

#CHC9677

DOH - Nassau County Health

Department

37203 Pecan St

Hilliard, FL 32046

(904) 530-6781

English, Spanish, Vietnamese

M-T 8am-5pm

W-Th 8am-5pm

# DN14307 Gupton, Frank

NPI: 1962411876 LIC: DN14307

CERTIFICATIONS :

• Inhalation Sedation

# DN10644 Steen, Phillip

NPI: 1215078506 LIC: DN10644

CERTIFICATIONS :

• Inhalation Sedation

#CHC9678

DOH - Nassau County Health

Department

86207 Felmor Rd

Yulee, FL 32097

(904) 875-6110

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN14307 Gupton, Frank

NPI: 1962411876 LIC: DN14307

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 40 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 41: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

• Inhalation Sedation

# DN10644 Steen, Phillip

NPI: 1215078506 LIC: DN10644

CERTIFICATIONS :

• Inhalation Sedation

OKALOOSA COUNTY

DENTIST

#FQHC013738

Crestview Dental Center

800 Hospital Dr.

Crestview, FL 32539

www.northfloridamedicalcenters.org

(850) 423-4603

English

M-T 8am-5pm

W-F 8am-5pm

# DN11230 Cherkinsky, Jordan

NPI: 1184637787 LIC: DN11230

CERTIFICATIONS :

# DN24185 Durham, Dominique

NPI: 1053972257 LIC: DN24185

CERTIFICATIONS :

OKEECHOBEE COUNTY

DENTIST

#FQHC020247

Florida Community Health

Centers, Inc.

2015 Us Highway 441

Okeechobee, FL 34972

www.fchcinc.org

(863) 763-1951

English, Spanish

M 8am - 6pm, T 8am - 5pm

W-Th 8am-5pm

# DN20720 Blackwood, Alberto

NPI: 1487057303 LIC: DN20720

CERTIFICATIONS :

# DN13607 Morales, Carlos

NPI: 1457310559 LIC: DN13607

CERTIFICATIONS :

# DN14000 Naryshkin, George

NPI: 1730395773 LIC: DN14000

CERTIFICATIONS :

# DN18121 Palacios, Eric

NPI: 1376778084 LIC: DN18121

CERTIFICATIONS :

# DN13771 Sanchez, Armando

NPI: 1992764930 LIC: DN13771

CERTIFICATIONS :

# DN13207 Zayas, Alida

NPI: 1639148968 LIC: DN13207

CERTIFICATIONS :

ORANGE COUNTY

DENTIST

#011595

A.K.M.W. Islam, BDS, P.A.

1925 E. Michigan St Ste 101

Orlando, FL 32806

(407) 896-6336

English, Arabic, Bengali, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN11823 Islam, A.K.M.W.

NPI: 1225048796 LIC: DN11823

CERTIFICATIONS :

#FQHC7785

Apopka Dental (Community

Health Ctr)

210 E. Seventh Street

Apopka, FL 32703

chcsl.org

(407) 905-8827

English, Spanish, Creoles and Pidgins,

French-based(other)

M 8am - 6pm, T 8am - 7pm

W-Th 8am-5pm

# DN12870 Browning, Lisa

NPI: 1457570103 LIC: DN12870

CERTIFICATIONS :

# DN11858 Palomeque, Theresa

NPI: 1386618544 LIC: DN11858

CERTIFICATIONS :

• Inhalation Sedation

# DN22449 Stewart, Elizabeth

NPI: 1891155271 LIC: DN22449

CERTIFICATIONS :

# DN10172 Stewart, Gregg

NPI: 1619977733 LIC: DN10172

CERTIFICATIONS :

# DN18247 Wray, Roger

NPI: 1528026630 LIC: DN18247

CERTIFICATIONS :

#009736

Artistic Smiles of Orlando

3592 Aloma Ave, Ste 1

Winter Park, FL 32792

artisticsmilesoorlando.com

(407) 678-7744

English, Spanish, Hindi

M-T 8am-5pm

W-Th 8am-5pm

# DN15961 Dhamija, Jugnu

NPI: 1568781227 LIC: DN15961

CERTIFICATIONS :

#FQHC9097

Central Florida Family Health

Center, Inc.

5730 Lake Underhill Road

Orlando, FL 32807

mytruehealth.org

(407) 322-8645

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN20946 Nguyen, David

NPI: 1811398423 LIC: DN20946

CERTIFICATIONS :

# DN17610 Pinnock, Alyssa

NPI: 1003987157 LIC: DN17610

CERTIFICATIONS :

#FQHC9816

Central Florida Family Health

Center, Inc.

11881 A-E Colonial Drive

Orlando, FL 32826

www.mytruehealth.org

(407) 322-8645

English, Spanish, Vietnamese

M-T 8am-6pm

W-Th 8am-6pm

# DN20946 Nguyen, David

NPI: 1811398423 LIC: DN20946

CERTIFICATIONS :

# DN17610 Pinnock, Alyssa

NPI: 1003987157 LIC: DN17610

CERTIFICATIONS :

#FQHC7971

Community Health Centers, Inc.

13275 W. Colonial Drive

Winter Garden, FL 34787

(407) 905-8827

English, Spanish

M 8am - 6pm, T 8am - 7pm

W-Th 8am-5pm

# DN18690 Nguyen, Kathleen

NPI: 1013143544 LIC: DN18690

CERTIFICATIONS :

• Inhalation Sedation

# DN22449 Stewart, Elizabeth

NPI: 1891155271 LIC: DN22449

CERTIFICATIONS :

#CHC10239

DOH - Orange County Health

Department

5449 S. Semoran Blvd, Ste 19B

Orlando, FL 32822

(407) 723-5264

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN17407 Bello, Andres

NPI: 1487615019 LIC: DN17407

CERTIFICATIONS :

# DN10829 Russo, Richard

NPI: 1063553774 LIC: DN10829

CERTIFICATIONS :

#FQHC7786

Eatonville Dental (Community

Health Center)

7900 Forest City Road

Orlando, FL 32810

(407) 905-8827

English, Spanish

M-T 8am-6pm

W-Th 8am-5pm

# DN15208 Mcdowell-Travis, Janet

NPI: 1992072540 LIC: DN15208

CERTIFICATIONS :

# DN15582 Nicola, Rania

NPI: 1033186986 LIC: DN15582

CERTIFICATIONS :

# DN22449 Stewart, Elizabeth

NPI: 1891155271 LIC: DN22449

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 41 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 42: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN10172 Stewart, Gregg

NPI: 1619977733 LIC: DN10172

CERTIFICATIONS :

#FQHC7970

Lake Ellenor Dental (Community

Health Ctr)

6101 Lake Ellenor Dr. Ste 106

Orlando, FL 32809

www.chcfl.org

(407) 905-8827

Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN12870 Browning, Lisa

NPI: 1457570103 LIC: DN12870

CERTIFICATIONS :

# DN13946 Estrada, Luis

NPI: 1245258565 LIC: DN13946

CERTIFICATIONS :

• Inhalation Sedation

# DN19362 Gonzalez, Patricia

NPI: 1760633739 LIC: DN19362

CERTIFICATIONS :

• Inhalation Sedation

# DN22449 Stewart, Elizabeth

NPI: 1891155271 LIC: DN22449

CERTIFICATIONS :

# DN10172 Stewart, Gregg

NPI: 1619977733 LIC: DN10172

CERTIFICATIONS :

#007936

LGB Dental LLC

4638 S. Orange Blossom Trail

Orlando, FL 32839

(407) 251-2223

English, Spanish, French

T 9am - 5pm

W-F 9am-5pm

# DN16942 Bobadilla, Luz

NPI: 1942321765 LIC: DN16942

CERTIFICATIONS :

#007687

OBT Dental Spa LLC

9753 S. Orange Blossom Trail #105

Orlando, FL 32837

(407) 857-8585

English, Spanish, Hindi

M-T 8am-4pm

W-F 8am-4pm

# DN19368 Anjum, Sumaya

NPI: 1821385931 LIC: DN19368

CERTIFICATIONS :

# DN16586 Olmos, Rodolfo

NPI: 1679616577 LIC: DN16586

CERTIFICATIONS :

# DN21642 Romero- Quevedo,

Margarita

NPI: 1861866782 LIC: DN21642

CERTIFICATIONS :

#FQHC011105

Orange Blossom Family Health

232 North Orange Blossom Trail

Orlando, FL 32805

(407) 428-5751

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-4pm

W-F 8am-4pm

# DN19583 Acosta, Edwin

NPI: 1578729711 LIC: DN19583

CERTIFICATIONS :

# DN19935 Keskar, Meghan

NPI: 1417205790 LIC: DN19935

CERTIFICATIONS :

# DN11833 Lim, Peter

NPI: 1821022526 LIC: DN11833

CERTIFICATIONS :

# DN23622 Pacheco, Magda

NPI: 1699264424 LIC: DN23622

CERTIFICATIONS :

#FQHC7784

Pine Hills Dental (Community

Health Center)

840 Mercy Drive

Orlando, FL 32810

www.chcfh.og

(407) 905-8827

English, Spanish, Creoles and Pidgins,

French-based(other)

M 8am - 5pm, T 8am - 6pm

W-Th 8am-5pm

# DN16298 Chery, Pascale

NPI: 1235138439 LIC: DN16298

CERTIFICATIONS :

# DN22449 Stewart, Elizabeth

NPI: 1891155271 LIC: DN22449

CERTIFICATIONS :

#021739

Yes! Dental Associates of Florida

12554 S. John Young Parkway, Ste

104

Orlando, FL 32837

(407) 847-8000

English, Spanish

M-T 7am-3pm

Th-F 7am-3pm

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN16372 Katsur, Justin

NPI: 1275592040 LIC: DN16372

CERTIFICATIONS :

• Inhalation Sedation

ORAL SURGEON

#018735

Central Florida Institute of Oral

Surgery & Dental Implants

320 N. Edinburg Drive Ste A

Winter Park, FL 32792

www.centralfloridaos.com

(407) 951-6554

English, Spanish

M-T 7am-5pm

W-Th 7am-5pm

# DN10476 Digney, J. Michael

NPI: 1780792770 LIC: DN10476

CERTIFICATIONS :

• General Anesthesia

# DN19378 Samaniego, Juan

NPI: 1467692129 LIC: DN19378

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16473 Walcott, Sean

NPI: 1841250743 LIC: DN16473

CERTIFICATIONS :

• General Anesthesia

OSCEOLA COUNTY

DENTIST

#013248

Fortune Dental

2324 Fortune Road

Kissimmee, FL 34744

(407) 348-2002

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN19368 Anjum, Sumaya*

NPI: 1821385931 LIC: DN19368

CERTIFICATIONS :

# DN16586 Olmos, Rodolfo*

NPI: 1679616577 LIC: DN16586

CERTIFICATIONS :

# DN21642 Romero- Quevedo,

Margarita*

NPI: 1861866782 LIC: DN21642

CERTIFICATIONS :

#013246

Hallmark Dental

1014 Buenaventura Blvd

Kissimmee, FL 34743

(407) 344-2400

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN16586 Olmos, Rodolfo

NPI: 1679616577 LIC: DN16586

CERTIFICATIONS :

# DN20125 Puerto, Sandra

NPI: 1972941961 LIC: DN20125

CERTIFICATIONS :

# DN21642 Romero- Quevedo,

Margarita

NPI: 1861866782 LIC: DN21642

CERTIFICATIONS :

#012264

Mid Florida Dental Associates

809 E Oak St Ste 101

Kissimmee, FL 34744

(407) 870-5004

English, Spanish, Hindi

M-T 8am-4pm

W-F 8am-4pm

# DN10632 Sharma, Rajesh

NPI: 1134212103 LIC: DN10632

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 42 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 43: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

#FQHC016506

Osceola Community Centers @

St. Cloud

1050 Grape Ave.

Saint Cloud, FL 34769

(407) 943-8600

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN14586 Henninger, Rosalba

NPI: 1598842668 LIC: DN14586

CERTIFICATIONS :

# DN20490 Powell, Makom

NPI: 1154745552 LIC: DN20490

CERTIFICATIONS :

#FQHC016507

Osceola Community Health

Centers @ Intercession City

1703 Business Center Lane

Kissimmee, FL 34758

(407) 943-8600

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15786 Ferro, David

NPI: 1063451326 LIC: DN15786

CERTIFICATIONS :

# DN14586 Henninger, Rosalba

NPI: 1598842668 LIC: DN14586

CERTIFICATIONS :

#FQHC016505

Osceola Community Health

Centers @ Kissimmee

1875 Fortune Rd.

Kissimmee, FL 34744

(407) 943-8600

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15786 Ferro, David

NPI: 1063451326 LIC: DN15786

CERTIFICATIONS :

#FQHC016508

Osceola Community Health

Centers @Poinciana

109 N. Doverplum Ave.

Kissimmee, FL 34758

(407) 943-8600

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15786 Ferro, David

NPI: 1063451326 LIC: DN15786

CERTIFICATIONS :

# DN14586 Henninger, Rosalba

NPI: 1598842668 LIC: DN14586

CERTIFICATIONS :

# DN20490 Powell, Makom

NPI: 1154745552 LIC: DN20490

CERTIFICATIONS :

#015403

Yes! Dental Associates of Florida

701 E. Oak Street Ste B

Kissimmee, FL 34744

(407) 847-8000

English, Spanish

M-T 9am-7pm

W 9am-5pm, Th 8am-3pm,F 8am-1pm

# DN17219 Colon, Agdha

NPI: 1487614533 LIC: DN17219

CERTIFICATIONS :

# DN16372 Katsur, Justin

NPI: 1275592040 LIC: DN16372

CERTIFICATIONS :

• Inhalation Sedation

ORAL SURGEON

#011436

Kissimmee Oral Surgery

3172 Bill Beck Blvd

Kissimmee, FL 34744

(407) 483-4939

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN17160 Ason, Raphael

NPI: 1659555001 LIC: DN17160

CERTIFICATIONS :

• General Anesthesia

PALM BEACH COUNTY

DENTIST

#016765

Bella Sonrisa Dental

3729 Lake Worth Rd

Palm Springs, FL 33461

(561) 201-8078

English, Spanish

M 10am - 5pm,

W 10am-5pm,

S 10am - 1pm

# DN20246 Lago-Sanchez, Idelbis

NPI: 1003248824 LIC: DN20246

CERTIFICATIONS :

#022294

Boynton Beach Mall Dental PA

801 N. Congress Ave, Ste 185D

Boynton Beach, FL 33426

(561) 369-7199

English, Russian, Spanish

M-T 10am-6pm

W-F 10am-6pm

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

# DN19470 Maniglia, Marielba

NPI: 1063793644 LIC: DN19470

CERTIFICATIONS :

#022544

Cagigas Dental Services LLC

2311 10Th Ave N, Ste 14

Lake Worth, FL 33461

(561) 814-2888

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

S 8am - 5pm

# DN15662 Gordon, Robert

NPI: 1578582359 LIC: DN15662

CERTIFICATIONS :

#FQHC016394

CL Brumback Primary Care

Clinics

1250 Southwinds Dr

Lantana, FL 33462

(561) 370-1306

Creoles and Pidgins,

English-based(other), English,

Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN15769 Alonso, Zenaida*

NPI: 1275586836 LIC: DN15769

CERTIFICATIONS :

#006577

Cross County Dental

4288 Okeechobee Blvd

West Palm Beach, FL 33409

(561) 683-6247

Russian, Spanish

M-T 10am-5pm

W 8am-5pm, Th 10am-5pm,F

10am-2pm

S 9am - 2pm

# DN20710 Gonzalez, Kely

NPI: 1952717027 LIC: DN20710

CERTIFICATIONS :

# DN20151 Gonzalez, Kenia

NPI: 1578902813 LIC: DN20151

CERTIFICATIONS :

# DN12167 Kuntsmann, Vivian

NPI: 1104995539 LIC: DN12167

CERTIFICATIONS :

#013217

Dr. Michael D. Quasha

4520 Donald Ross Road, Ste 105

Palm Beach Gardens, FL 33418

(561) 799-5558

English, Arabic, French, Spanish

M-T 9am-4pm

W-F 9am-4pm

# DN16005 Quasha, Michael

NPI: 1972674448 LIC: DN16005

CERTIFICATIONS :

#006676

Florida Dental & Denture Center

1901 S. Federal Hwy

Boynton Beach, FL 33435

(561) 738-5974

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN13168 Semeah, Yves

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 43 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 44: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

NPI: 1326152463 LIC: DN13168

CERTIFICATIONS :

#006678

Florida Dental & Denture Center

III

2945 N. Australian Ave

West Palm Beach, FL 33407

(561) 844-0033

Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN8737 Newman, Donald

NPI: 1356476857 LIC: DN8737

CERTIFICATIONS :

# DN13168 Semeah, Yves

NPI: 1326152463 LIC: DN13168

CERTIFICATIONS :

#FQHC014906

Foundcare, Inc.

2330 S. Congress Ave

West Palm Beach, FL 33406

(561) 432-5849

English, Arabic, Creoles and Pidgins,

French-based(other), French, Spanish

M 8am - 5pm, T 8am - 7pm

W-Th 8am-5pm

# DN12194 Rampertaap, Maheswar

NPI: 1235290602 LIC: DN12194

CERTIFICATIONS :

#FQHC014974

Genesis Community Health Inc

181 Crawford Blvd

Boca Raton, FL 33432

(561) 235-5477

English, Spanish, Creoles and Pidgins

(other)

T 8am - 5pm

W-Th 8am-5pm

# DN20219 Elkind, Jaime

NPI: 1437567146 LIC: DN20219

CERTIFICATIONS :

# DN13425 Ferlita, David

NPI: 1154333235 LIC: DN13425

CERTIFICATIONS :

# DN21026 Kniznik, Carla

NPI: 1811134612 LIC: DN21026

CERTIFICATIONS :

# DN18189 Rizzardi, Suzanne

NPI: 1861666232 LIC: DN18189

CERTIFICATIONS :

#FQHC017622

Genesis Community Health, Inc.

2623 S. Seacrest Blvd Ste 112

Boynton Beach, FL 33435

(561) 810-8790

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN20219 Elkind, Jaime

NPI: 1437567146 LIC: DN20219

CERTIFICATIONS :

# DN13425 Ferlita, David

NPI: 1154333235 LIC: DN13425

CERTIFICATIONS :

# DN21026 Kniznik, Carla

NPI: 1811134612 LIC: DN21026

CERTIFICATIONS :

# DN18189 Rizzardi, Suzanne

NPI: 1861666232 LIC: DN18189

CERTIFICATIONS :

#021605

Greenberg Dental & Orthodontics

701 N. Congress Ave, Ste 9

Boynton Beach, FL 33426

(561) 740-2013

English, Spanish

M-T 8am-4pm

W 11am-7pm, Th 10am-6pm,F

8am-4pm

# DN12124 Barrett, Steven

NPI: 1811957046 LIC: DN12124

CERTIFICATIONS :

# DN18753 Daneshpajouh, Sara

NPI: 1982836003 LIC: DN18753

CERTIFICATIONS :

# DN7501 Greenberg, Andrew

NPI: 1740240696 LIC: DN7501

CERTIFICATIONS :

# DN22932 Rincon, Karolina

NPI: 1790293595 LIC: DN22932

CERTIFICATIONS :

# DN22428 Salehi, Shiva

NPI: 1346696549 LIC: DN22428

CERTIFICATIONS :

# DN20824 Scarlett, Francesca

NPI: 1124437884 LIC: DN20824

CERTIFICATIONS :

# DN17455 Stein, Stacy

NPI: 1467637561 LIC: DN17455

CERTIFICATIONS :

#022594

Habashy Dental of Palm Beach

Gardens - Jupiter

4595 Northlake Blvd, Ste 103 & 114

Palm Beach Gardens, FL 33418

(561) 427-7711

English, Arabic, Spanish

M-T 8am-8pm

W-F 8am-8pm

S 8am - 5pm

# DN22543 Habashy, Peter

NPI: 1760919898 LIC: DN22543

CERTIFICATIONS :

#020193

Heavenly Smiles

135 South Us Highway 27

South Bay, FL 33493

(561) 996-0033

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 9am-5pm

W-Th 9am-5pm

# DN21975 Baldwin, Anthony

NPI: 1073066551 LIC: DN21975

CERTIFICATIONS :

#016856

Jaime R. Marquez DDS PA

7301A W. Palmetto Pk Road, Ste

204-A

Boca Raton, FL 33433

brocadentalsedationgroup.com

(561) 391-1114

English, Russian, Spanish

M-T 8am-6pm

W-Th 8am-6pm

# DN20355 Marquez, Jaime

NPI: 1750442992 LIC: DN20355

CERTIFICATIONS :

• Conscious Sedation

#019498

Lidia Suarez DDS Inc

1800 Forest Hill Blvd #A3-4

West Palm Beach, FL 33406

www.suarezlidiadds.com

(561) 249-6114

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN20107 Suarez Tabares, Lidia

NPI: 1780976795 LIC: DN20107

CERTIFICATIONS :

#021850

Nona Diamond Dental LLC

1696 S. Military Trail # B

West Palm Beach, FL 33415

(561) 791-6494

English, Spanish, Portuguese

M-T 8am-5pm

W-Th 8am-5pm

S 8am - 1pm

# DN20957 Correa, Ali

NPI: 1972815835 LIC: DN20957

CERTIFICATIONS :

#007645

Polo Dental

1905 Clint Moore Rd, Ste 200

Boca Raton, FL 33496

(561) 241-7656

English, Russian, Creoles and Pidgins,

French-based(other), Spanish

M 11am - 7pm, T 9am - 5pm

Th-F 9am-5pm

# DN23676 Aldaya, Robair

NPI: 1508344599 LIC: DN23676

CERTIFICATIONS :

# DN20845 Bradley, Alijah

NPI: 1003224148 LIC: DN20845

CERTIFICATIONS :

# DN10457 Broggi, Edward

NPI: 1215955190 LIC: DN10457

CERTIFICATIONS :

# DN24614 Cerrutti, Juan

NPI: 1992233167 LIC: DN24614

CERTIFICATIONS :

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN23511 Nguyen, Chi

NPI: 1811482656 LIC: DN23511

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 44 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 45: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

CERTIFICATIONS :

• Inhalation Sedation

# DN23454 Nguyen, Michelle

NPI: 1033603733 LIC: DN23454

CERTIFICATIONS :

• Inhalation Sedation

# DN24429 Shahriari, Varahram

NPI: 1952954778 LIC: DN24429

CERTIFICATIONS :

# DN16481 Zadov, Marianna

NPI: 1104903301 LIC: DN16481

CERTIFICATIONS :

• Inhalation Sedation

#014988

Polo Dental

4700 N. Congress Ave, Ste 302

West Palm Beach, FL 33407

(561) 666-9691

English, Russian, Creoles and Pidgins,

English-based(other), Spanish

M 9am - 5pm, T 10am - 6pm

W-F 10am-6pm

# DN20845 Bradley, Alijah

NPI: 1003224148 LIC: DN20845

CERTIFICATIONS :

# DN10457 Broggi, Edward

NPI: 1215955190 LIC: DN10457

CERTIFICATIONS :

# DN24614 Cerrutti, Juan

NPI: 1992233167 LIC: DN24614

CERTIFICATIONS :

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN23511 Nguyen, Chi

NPI: 1811482656 LIC: DN23511

CERTIFICATIONS :

• Inhalation Sedation

# DN23454 Nguyen, Michelle

NPI: 1033603733 LIC: DN23454

CERTIFICATIONS :

• Inhalation Sedation

# DN24429 Shahriari, Varahram

NPI: 1952954778 LIC: DN24429

CERTIFICATIONS :

# DN16481 Zadov, Marianna

NPI: 1104903301 LIC: DN16481

CERTIFICATIONS :

• Inhalation Sedation

#008259

Premiere Dental Care, PL

600 S Dixie Hwy, Ste 105

West Palm Beach, FL 33401

(561) 820-8898

English, Chinese Mandarin, Russian,

Spanish

M-T 9am-6pm

W-F 9am-6pm

# DN12723 Hui, Tin

NPI: 1952408619 LIC: DN12723

CERTIFICATIONS :

#013199

Professional Dental Team, PA

5100 South Dixie Highway, Ste #2

West Palm Beach, FL 33405

(561) 721-2525

English, Spanish

M-T 9am-5pm

Th-F 9am-5pm

# DN18296 Galindo, Olga

NPI: 1396903746 LIC: DN18296

CERTIFICATIONS :

#010039

Quantum Dental

1034 Gateway Blvd, Ste 101

Boynton Beach, FL 33426

(561) 249-2585

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

S 9am - 2pm

# DN17323 Deyab, Tim

NPI: 1124119474 LIC: DN17323

CERTIFICATIONS :

#016245

Royal Dental

1301 N. Congress, Ste 110

Boynton Beach, FL 33426

(561) 292-0155

English, Russian, Spanish

M-T 9am-5pm

W 9am-5pm, Th 10am-6pm,F

9am-5pm

# DN10457 Broggi, Edward

NPI: 1215955190 LIC: DN10457

CERTIFICATIONS :

# DN24614 Cerrutti, Juan

NPI: 1992233167 LIC: DN24614

CERTIFICATIONS :

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN23511 Nguyen, Chi

NPI: 1811482656 LIC: DN23511

CERTIFICATIONS :

• Inhalation Sedation

# DN23454 Nguyen, Michelle

NPI: 1033603733 LIC: DN23454

CERTIFICATIONS :

• Inhalation Sedation

# DN24429 Shahriari, Varahram

NPI: 1952954778 LIC: DN24429

CERTIFICATIONS :

# DN16481 Zadov, Marianna

NPI: 1104903301 LIC: DN16481

CERTIFICATIONS :

• Inhalation Sedation

#007513

Shapiro Family Dentistry

2247 Palm Beach Lakes Ste 104

West Palm Beach, FL 33409

(561) 684-2282

English, Spanish

M-T 8am-6pm

W-Th 8am-6pm

S 8am - 12pm

# DN22032 Sanchez, Jairo

NPI: 1376994236 LIC: DN22032

CERTIFICATIONS :

# DN15490 Shapiro, Dari

NPI: 1801099643 LIC: DN15490

CERTIFICATIONS :

• Inhalation Sedation

# DN15327 Shapiro, Seth

NPI: 1114136223 LIC: DN15327

CERTIFICATIONS :

#012861

Shapiro Family Dentistry

7805 Nw Beacon Square Blvd Ste 101

Boca Raton, FL 33487

(561) 998-0901

English, Spanish, Creoles and Pidgins,

French-based(other)

M-T 9am-5pm

W-Th 9am-5pm

# DN22032 Sanchez, Jairo

NPI: 1376994236 LIC: DN22032

CERTIFICATIONS :

# DN15490 Shapiro, Dari

NPI: 1801099643 LIC: DN15490

CERTIFICATIONS :

• Inhalation Sedation

# DN15327 Shapiro, Seth

NPI: 1114136223 LIC: DN15327

CERTIFICATIONS :

#021758

Shapiro Family Dentistry

9868 S State Road 7, Ste 200

Boynton Beach, FL 33472

(561) 877-3313

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-6pm

W-F 8am-6pm

S 8am - 3pm

# DN23031 Novak, Stephen

NPI: 1497267025 LIC: DN23031

CERTIFICATIONS :

# DN22032 Sanchez, Jairo

NPI: 1376994236 LIC: DN22032

CERTIFICATIONS :

# DN15490 Shapiro, Dari

NPI: 1801099643 LIC: DN15490

CERTIFICATIONS :

• Inhalation Sedation

# DN15327 Shapiro, Seth

NPI: 1114136223 LIC: DN15327

CERTIFICATIONS :

#015450

Sky Dental

625 Se 2Nd Ave, Ste D

Boynton Beach, FL 33435

(561) 739-3222

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN14857 Gonzalez-Fujara, Maria

NPI: 1922133099 LIC: DN14857

CERTIFICATIONS :

#022481

Smile Creation Dental

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 45 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 46: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

3319 State Road 7, Ste 201

Wellington, FL 33449

(561) 557-2542

English, Spanish, Vietnamese

M-T 8am-5pm

W-F 8am-5pm

# DN20509 Vo, Danny

NPI: 1629181698 LIC: DN20509

CERTIFICATIONS :

ENDODONTICS

#006577

Cross County Dental

4288 Okeechobee Blvd

West Palm Beach, FL 33409

(561) 683-6247

Russian, Spanish

M-T 10am-5pm

W 8am-5pm, Th 10am-5pm,F

10am-2pm

S 9am - 2pm

# DN13421 Gittess, Robert

NPI: 1922137058 LIC: DN13421

CERTIFICATIONS :

ORAL SURGEON

#019857

Surgical Arts of Boca Raton

9980 N. Central Park Blvd #113

Boca Raton, FL 33428

(561) 717-3660

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN16048 Portnof, Jason

NPI: 1760613426 LIC: DN16048

CERTIFICATIONS :

• Board Certification

• General Anesthesia

• Inhalation Sedation

PERIODONTICS

#007645

Polo Dental

1905 Clint Moore Rd, Ste 200

Boca Raton, FL 33496

(561) 241-7656

English, Russian, Creoles and Pidgins,

French-based(other), Spanish

M 11am - 7pm, T 9am - 5pm

Th-F 9am-5pm

# DN23115 Mendoza, Juan

NPI: 1821326430 LIC: DN23115

CERTIFICATIONS :

• Inhalation Sedation

# DN11699 Simon, David

NPI: 1508303587 LIC: DN11699

CERTIFICATIONS :

• Oral / Enteral Sedation

#014988

Polo Dental

4700 N. Congress Ave, Ste 302

West Palm Beach, FL 33407

(561) 666-9691

English, Russian, Creoles and Pidgins,

English-based(other), Spanish

M 9am - 5pm, T 10am - 6pm

W-F 10am-6pm

# DN23115 Mendoza, Juan

NPI: 1821326430 LIC: DN23115

CERTIFICATIONS :

• Inhalation Sedation

# DN11699 Simon, David

NPI: 1508303587 LIC: DN11699

CERTIFICATIONS :

• Oral / Enteral Sedation

#016245

Royal Dental

1301 N. Congress, Ste 110

Boynton Beach, FL 33426

(561) 292-0155

English, Russian, Spanish

M-T 9am-5pm

W 9am-5pm, Th 10am-6pm,F

9am-5pm

# DN23115 Mendoza, Juan

NPI: 1821326430 LIC: DN23115

CERTIFICATIONS :

• Inhalation Sedation

# DN11699 Simon, David

NPI: 1508303587 LIC: DN11699

CERTIFICATIONS :

• Oral / Enteral Sedation

#021758

Shapiro Family Dentistry

9868 S State Road 7, Ste 200

Boynton Beach, FL 33472

(561) 877-3313

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 8am-6pm

W-F 8am-6pm

S 8am - 3pm

# DN18002 Fotek, Pawel

NPI: 1336331693 LIC: DN18002

CERTIFICATIONS :

• Board Certification

• Conscious Sedation

PASCO COUNTY

DENTIST

#FQHC014534

Premier Community HealthCare

Group Inc.

2114 Seven Springs Blvd

New Port Richey, FL 34655

(352) 518-2000

English, Spanish

M 7am - 7pm, T 7am - 4pm

W-F 7am-4pm

# DN19998 Nazco-Batista, Maria

NPI: 1093050676 LIC: DN19998

CERTIFICATIONS :

• Inhalation Sedation

# DN20707 Painter, Lisa

NPI: 1083031926 LIC: DN20707

CERTIFICATIONS :

# DN13891 Peralta, Jose*

NPI: 1962462036 LIC: DN13891

CERTIFICATIONS :

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

#FQHC011082

Premier Community HealthCare

Group, Inc.

37944 Pasco Ave

Dade City, FL 33525

PREMIERHC.ORG

(352) 518-2000

English, Spanish

M 7am - 7pm, T 7am - 4pm

W-F 7am-4pm

# DN11556 Baker, Wayne

NPI: 1699833947 LIC: DN11556

CERTIFICATIONS :

# DN14806 Barinas-Duval, Froilan

NPI: 1699748442 LIC: DN14806

CERTIFICATIONS :

• Inhalation Sedation

# HAD33 Modaff, Michelle

NPI: 1497768295 LIC: HAD33

CERTIFICATIONS :

# DN19998 Nazco-Batista, Maria

NPI: 1093050676 LIC: DN19998

CERTIFICATIONS :

• Inhalation Sedation

# DN20707 Painter, Lisa

NPI: 1083031926 LIC: DN20707

CERTIFICATIONS :

# DN13891 Peralta, Jose

NPI: 1962462036 LIC: DN13891

CERTIFICATIONS :

# DN22607 Rotaru, Ion

NPI: 1558899658 LIC: DN22607

CERTIFICATIONS :

ORAL SURGEON

#012639

Tampa Bay Institute of Oral

Surgery & Dental Implants

19445 Shumard Oak Dr Ste 101

Land O Lakes, FL 34638

(813) 909-2354

English, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN19301 Caribas-Mendible,

Alejandro

NPI: 1013204122 LIC: DN19301

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN23977 Elmohd, Tarik

NPI: 1538556329 LIC: DN23977

CERTIFICATIONS :

PINELLAS COUNTY

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 46 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 47: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

DENTIST

#011420

A-1 Dental

29605 Us 19 North, Ste 350

Clearwater, FL 33761

(727) 786-6649

English, Gujarati, Hindi

M 9am - 5pm, T 10am - 6pm

F 9am-5pm

# DN11504 Patel, Guarangi*

NPI: 1326123993 LIC: DN11504

CERTIFICATIONS :

#FQHC011250

Community Health Centers of

Pinellas, Inc

1344 22Nd Street S

St Petersburg, FL 33712

(727) 824-8181

English, Spanish

M-T 7am-6pm

W-Th 7am-6pm

# DN22253 Carter, Jade

NPI: 1487968467 LIC: DN22253

CERTIFICATIONS :

# DN19885 Dougherty, Erin

NPI: 1043565807 LIC: DN19885

CERTIFICATIONS :

# DN21962 Trenkova, Violeta

NPI: 1841641792 LIC: DN21962

CERTIFICATIONS :

#FQHC011251

Community Health Centers of

Pinellas, Inc

702 Jasmine Way

Clearwater, FL 33756

(727) 824-8181

English, Spanish

M 7am - 6pm, T 7am - 4pm

W 7am-4pm, Th 7am-6pm,F 7am-4pm

# DN21300 Alonso, Anamevys

NPI: 1669868147 LIC: DN21300

CERTIFICATIONS :

# DN22253 Carter, Jade

NPI: 1487968467 LIC: DN22253

CERTIFICATIONS :

# DN9873 Lansmann, Richard

NPI: 1427355585 LIC: DN9873

CERTIFICATIONS :

#022289

Countryside Mall Dental PA

27001 Us Highway 19 N, Ste 1031B

Clearwater, FL 33761

(727) 669-1600

English, Russian, Spanish

M-T 10am-9pm

W-F 10am-9pm

S 10am - 9pm, Su 11am - 6pm

# DN16377 Krasnov, Rostislav

NPI: 1942267935 LIC: DN16377

CERTIFICATIONS :

#CHC10109

DOH - Pinellas County Health

Department

205 Dr. Martin Luther King St No.

Saint Petersburg, FL 33701

(727) 824-6900

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN12823 Beers, Eda

NPI: 1437118460 LIC: DN12823

CERTIFICATIONS :

• Inhalation Sedation

# DN12874 Chekan, Theodore

NPI: 1992750426 LIC: DN12874

CERTIFICATIONS :

# DN13061 Engelman, Sharon

NPI: 1215996384 LIC: DN13061

CERTIFICATIONS :

# DN18300 Gatons, Yelena

NPI: 1326202474 LIC: DN18300

CERTIFICATIONS :

# DN12521 Lense, Pedro

NPI: 1154380913 LIC: DN12521

CERTIFICATIONS :

# DN11690 Saraydar, Haychell

NPI: 1750343257 LIC: DN11690

CERTIFICATIONS :

# DN19476 Thomas, Kelly

NPI: 1821374828 LIC: DN19476

CERTIFICATIONS :

# DN11179 Wong, Elaine

NPI: 1295794360 LIC: DN11179

CERTIFICATIONS :

#CHC10125

DOH - Pinellas County Health

Department

8751 Ulmerton Rd

Largo, FL 33771

(727) 524-4410

Spanish, English

M-T 8am-5pm

W-F 8am-5pm

# DN12823 Beers, Eda

NPI: 1437118460 LIC: DN12823

CERTIFICATIONS :

• Inhalation Sedation

# DN12874 Chekan, Theodore

NPI: 1992750426 LIC: DN12874

CERTIFICATIONS :

# DN13061 Engelman, Sharon

NPI: 1215996384 LIC: DN13061

CERTIFICATIONS :

# DN18300 Gatons, Yelena

NPI: 1326202474 LIC: DN18300

CERTIFICATIONS :

# DN11984 Gonzalez, Jose

NPI: 1992706691 LIC: DN11984

CERTIFICATIONS :

# DN12521 Lense, Pedro

NPI: 1154380913 LIC: DN12521

CERTIFICATIONS :

# DN11690 Saraydar, Haychell

NPI: 1750343257 LIC: DN11690

CERTIFICATIONS :

# DN19476 Thomas, Kelly

NPI: 1821374828 LIC: DN19476

CERTIFICATIONS :

# DN11179 Wong, Elaine

NPI: 1295794360 LIC: DN11179

CERTIFICATIONS :

#CHC10126

DOH - Pinellas County Health

Department

12420 130Th Ave North

Largo, FL 33774

(727) 824-6900

Spanish, English

T 9am - 5pm

# DN12874 Chekan, Theodore

NPI: 1992750426 LIC: DN12874

CERTIFICATIONS :

# DN12521 Lense, Pedro

NPI: 1154380913 LIC: DN12521

CERTIFICATIONS :

#CHC10127

DOH - Pinellas County Health

Department

6350 76Th Ave North

Pinellas Park, FL 33781

(727) 547-7780

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN12823 Beers, Eda

NPI: 1437118460 LIC: DN12823

CERTIFICATIONS :

• Inhalation Sedation

# DN12874 Chekan, Theodore

NPI: 1992750426 LIC: DN12874

CERTIFICATIONS :

# DN13061 Engelman, Sharon

NPI: 1215996384 LIC: DN13061

CERTIFICATIONS :

# DN18300 Gatons, Yelena

NPI: 1326202474 LIC: DN18300

CERTIFICATIONS :

# DN11984 Gonzalez, Jose

NPI: 1992706691 LIC: DN11984

CERTIFICATIONS :

# DN12521 Lense, Pedro

NPI: 1154380913 LIC: DN12521

CERTIFICATIONS :

# DN11690 Saraydar, Haychell

NPI: 1750343257 LIC: DN11690

CERTIFICATIONS :

# DN19476 Thomas, Kelly

NPI: 1821374828 LIC: DN19476

CERTIFICATIONS :

# DN17405 Ward, Tasha

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

# DN11179 Wong, Elaine

NPI: 1295794360 LIC: DN11179

CERTIFICATIONS :

#CHC10128

DOH - Pinellas County Health

Department

301 S. Disston Ave

Tarpon Springs, FL 34689

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 47 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 48: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(727) 485-1805

English, Spanish

M 8am - 5pm,

W 8am-5pm,

# DN12823 Beers, Eda

NPI: 1437118460 LIC: DN12823

CERTIFICATIONS :

• Inhalation Sedation

# DN12874 Chekan, Theodore

NPI: 1992750426 LIC: DN12874

CERTIFICATIONS :

# DN13061 Engelman, Sharon

NPI: 1215996384 LIC: DN13061

CERTIFICATIONS :

# DN18300 Gatons, Yelena

NPI: 1326202474 LIC: DN18300

CERTIFICATIONS :

# DN12521 Lense, Pedro

NPI: 1154380913 LIC: DN12521

CERTIFICATIONS :

# DN11690 Saraydar, Haychell

NPI: 1750343257 LIC: DN11690

CERTIFICATIONS :

# DN19476 Thomas, Kelly

NPI: 1821374828 LIC: DN19476

CERTIFICATIONS :

# DN17405 Ward, Tasha

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

# DN11179 Wong, Elaine

NPI: 1295794360 LIC: DN11179

CERTIFICATIONS :

#CHC10129

DOH - Pinellas County Health

Department

310 N. Myrtle Ave

Clearwater, FL 33755

(727) 275-6535

English, Spanish

M-T 8am-5pm

W-F 8am-5pm

# DN12823 Beers, Eda

NPI: 1437118460 LIC: DN12823

CERTIFICATIONS :

• Inhalation Sedation

# DN12874 Chekan, Theodore

NPI: 1992750426 LIC: DN12874

CERTIFICATIONS :

# DN13061 Engelman, Sharon

NPI: 1215996384 LIC: DN13061

CERTIFICATIONS :

# DN18300 Gatons, Yelena

NPI: 1326202474 LIC: DN18300

CERTIFICATIONS :

# DN12521 Lense, Pedro

NPI: 1154380913 LIC: DN12521

CERTIFICATIONS :

# DN11690 Saraydar, Haychell

NPI: 1750343257 LIC: DN11690

CERTIFICATIONS :

# DN19476 Thomas, Kelly

NPI: 1821374828 LIC: DN19476

CERTIFICATIONS :

# DN17405 Ward, Tasha

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

# DN11179 Wong, Elaine

NPI: 1295794360 LIC: DN11179

CERTIFICATIONS :

#010840

St. Petersburg Dental Clinic

9200 113Th Street N.

Seminole, FL 33772

(727) 394-6064

English, Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN8905 Porter, Thomas

NPI: 1578520375 LIC: DN8905

CERTIFICATIONS :

• Conscious Sedation

• Inhalation Sedation

# DN18620 Viera, Gretel

NPI: 1790915635 LIC: DN18620

CERTIFICATIONS :

#011546

Tyrone Square Mall Dental PA

6747 Tyrone Square

Saint Petersburg, FL 33710

(727) 345-6100

English, Russian, Spanish

M-T 10am-5pm

W-F 10am-5pm

# DN22246 Antezana, Mauricio

NPI: 1063876399 LIC: DN22246

CERTIFICATIONS :

# DN17412 Atkinson, William

NPI: 1942360862 LIC: DN17412

CERTIFICATIONS :

• Inhalation Sedation

# DN21812 Cabrera, Rene

NPI: 1518313675 LIC: DN21812

CERTIFICATIONS :

# DN22714 Fornes-Ferrero, Patricia

NPI: 1619407566 LIC: DN22714

CERTIFICATIONS :

# DN20945 Fornos, Jorge

NPI: 1831594415 LIC: DN20945

CERTIFICATIONS :

# DN22796 Gandhi, Poorvi

NPI: 1548631229 LIC: DN22796

CERTIFICATIONS :

# DN20710 Gonzalez, Kely

NPI: 1952717027 LIC: DN20710

CERTIFICATIONS :

# DN10511 Green, George

NPI: 1609094580 LIC: DN10511

CERTIFICATIONS :

# DN22451 Gruenberg, Alex

NPI: 1255844924 LIC: DN22451

CERTIFICATIONS :

# DN22242 Guerra, Vannette

NPI: 1598184327 LIC: DN22242

CERTIFICATIONS :

# DN24131 Krupnov, Vera

NPI: 1386202984 LIC: DN24131

CERTIFICATIONS :

# DN23402 Montenegro, Christian

NPI: 1144714445 LIC: DN23402

CERTIFICATIONS :

# DN22713 Morell, Omar

NPI: 1659801587 LIC: DN22713

CERTIFICATIONS :

# DN22702 Pham, Quynhnhu

NPI: 1609323948 LIC: DN22702

CERTIFICATIONS :

# DN21224 Ribot, Aliana

NPI: 1811377732 LIC: DN21224

CERTIFICATIONS :

# DN23021 Riboul, Sandrine

NPI: 1609227057 LIC: DN23021

CERTIFICATIONS :

• Inhalation Sedation

# DN23007 Rivera, Lina

NPI: 1760908743 LIC: DN23007

CERTIFICATIONS :

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

# DN20475 Santiago, Germaine

NPI: 1922341460 LIC: DN20475

CERTIFICATIONS :

# DN23257 Shippee, Rebecca

NPI: 1841778164 LIC: DN23257

CERTIFICATIONS :

# DN22695 Toribio Fabelo, Leydy

NPI: 1033639554 LIC: DN22695

CERTIFICATIONS :

• Inhalation Sedation

# DN18770 Trujillo, Madelene

NPI: 1881835767 LIC: DN18770

CERTIFICATIONS :

# DN21066 Uzunova-Dimova, Kalina

NPI: 1245540947 LIC: DN21066

CERTIFICATIONS :

PERIODONTICS

# DN13591 Nielsen, Pamela

NPI: 1124118245 LIC: DN13591

CERTIFICATIONS :

POLK COUNTY

DENTIST

#CHC7919

Central Florida Health Care

109 W. Wall St

Frostproof, FL 33843

(863) 635-4891

English, Spanish, Creoles and Pidgins,

English-based(other), French

M-T 7am-5pm

W-F 7am-5pm

# DN22245 Rubin, Joslyn

NPI: 1861940850 LIC: DN22245

CERTIFICATIONS :

# DN6990 Seifert, Thomas

NPI: 1255654232 LIC: DN6990

CERTIFICATIONS :

#CHC7921

Central Florida Health Care

305 W. Central Ave

Lake Wales, FL 33853

(863) 855-9718

Spanish, English

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 48 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 49: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

M-T 7am-5pm

W-F 7am-5pm

# DN13255 Cooper, Angela

NPI: 1912994914 LIC: DN13255

CERTIFICATIONS :

# DN20914 Hackstie, Joseph

NPI: 1932508405 LIC: DN20914

CERTIFICATIONS :

# DN18154 Mckenzie, Karen

NPI: 1821286287 LIC: DN18154

CERTIFICATIONS :

# DN22245 Rubin, Joslyn

NPI: 1861940850 LIC: DN22245

CERTIFICATIONS :

#FQHC020824

Central Florida Health Care, Inc

601 S. Florida Ave, Ste 6

Lakeland, FL 33801

(866) 234-8534

English, Spanish, Creoles and Pidgins,

French-based(other)

M-T 7am-6pm

Th-F 7am-6pm

# DN18203 Geller, Robert

NPI: 1669503280 LIC: DN18203

CERTIFICATIONS :

# DN24008 Pettit, Karen

NPI: 1285123414 LIC: DN24008

CERTIFICATIONS :

#FQHC021227

Central Florida Health Care, Inc

705 Ingraham Ave

Haines City, FL 33844

(863) 438-6900

English, Spanish, Creoles and Pidgins,

English-based(other)

M-T 7am-6pm

W-Th 7am-6pm

# HAD80 Antony, Archana

NPI: 1851607766 LIC: HAD80

CERTIFICATIONS :

# DN12871 Cardenas, Carlos

NPI: 1568649804 LIC: DN12871

CERTIFICATIONS :

# HAD92 Coello, Marla

NPI: 1891833620 LIC: HAD92

CERTIFICATIONS :

# DN13255 Cooper, Angela

NPI: 1912994914 LIC: DN13255

CERTIFICATIONS :

# DN18203 Geller, Robert

NPI: 1669503280 LIC: DN18203

CERTIFICATIONS :

# DN16346 Gomara, Denise

NPI: 1497887863 LIC: DN16346

CERTIFICATIONS :

# DN20914 Hackstie, Joseph

NPI: 1932508405 LIC: DN20914

CERTIFICATIONS :

# DN18154 Mckenzie, Karen

NPI: 1821286287 LIC: DN18154

CERTIFICATIONS :

# HAD33 Modaff, Michelle

NPI: 1497768295 LIC: HAD33

CERTIFICATIONS :

# DN22245 Rubin, Joslyn

NPI: 1861940850 LIC: DN22245

CERTIFICATIONS :

# DN6990 Seifert, Thomas

NPI: 1255654232 LIC: DN6990

CERTIFICATIONS :

# DN17405 Ward, Tasha

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

#FQHC011909

Central Florida Health Care, Inc.

1514 1St St North

Winter Haven, FL 33881

(866) 234-8534

Spanish, English, Creoles and Pidgins,

French-based(other)

M-T 7am-6pm

W-Th 7am-6pm

# DN12871 Cardenas, Carlos

NPI: 1568649804 LIC: DN12871

CERTIFICATIONS :

# DN18203 Geller, Robert

NPI: 1669503280 LIC: DN18203

CERTIFICATIONS :

#FQHC012686

Central Florida Health Care, Inc.

106 Nw 9Th Ave

Mulberry, FL 33860

(863) 425-6200

English, Spanish

M-T 7am-6pm

W-F 7am-6pm

# DN22773 Aiyede, Onize

NPI: 1306295712 LIC: DN22773

CERTIFICATIONS :

#FQHC015864

Central Florida Health Care, Inc.

201 Magnolia Ave Sw

Winter Haven, FL 33880

www.cfhconline.org

(866) 234-8534

English, Spanish, Creoles and Pidgins,

French-based(other)

M-T 7am-5pm

W-F 7am-5pm

# HAD80 Antony, Archana

NPI: 1851607766 LIC: HAD80

CERTIFICATIONS :

# DN13255 Cooper, Angela

NPI: 1912994914 LIC: DN13255

CERTIFICATIONS :

# DN18154 Mckenzie, Karen

NPI: 1821286287 LIC: DN18154

CERTIFICATIONS :

# DN22245 Rubin, Joslyn

NPI: 1861940850 LIC: DN22245

CERTIFICATIONS :

# DN6990 Seifert, Thomas

NPI: 1255654232 LIC: DN6990

CERTIFICATIONS :

# DN17405 Ward, Tasha

NPI: 1528087871 LIC: DN17405

CERTIFICATIONS :

#012845

Dental Associates of Bartow

2090 Flamingo Drive East

Bartow, FL 33830

(863) 614-1801

English

T 8am - 4pm

W-Th 8am-4pm

# DN18265 Fenton, Chelsea*

NPI: 1881842615 LIC: DN18265

CERTIFICATIONS :

• Inhalation Sedation

# DN17074 Mueller, William*

NPI: 1164574679 LIC: DN17074

CERTIFICATIONS :

# DN14392 Walding III, Stephen*

NPI: 1023160637 LIC: DN14392

CERTIFICATIONS :

#CHC10104

DOH - Polk County Health

Department

1805 Hobbs Road

Auburndale, FL 33823

(863) 519-7910

English, Spanish, Sign Languages

M-T 8am-5pm

W-F 8am-5pm

# DN11009 Ebner, Stephen

NPI: 1578652442 LIC: DN11009

CERTIFICATIONS :

• Inhalation Sedation

# DN15480 Rodriguez, Ana

NPI: 1184835985 LIC: DN15480

CERTIFICATIONS :

• Inhalation Sedation

# DN19400 Santos, Luis

NPI: 1821152232 LIC: DN19400

CERTIFICATIONS :

• Inhalation Sedation

#CHC10105

DOH - Polk County Health

Department

1700 Baker Ave East

Haines City, FL 33844

(863) 519-7910

English, Spanish

M 8am - 5pm, T 8am - 7pm

W-F 8am-5pm

# DN11009 Ebner, Stephen

NPI: 1578652442 LIC: DN11009

CERTIFICATIONS :

• Inhalation Sedation

# DN15480 Rodriguez, Ana

NPI: 1184835985 LIC: DN15480

CERTIFICATIONS :

• Inhalation Sedation

# DN19400 Santos, Luis

NPI: 1821152232 LIC: DN19400

CERTIFICATIONS :

• Inhalation Sedation

#CHC10106

DOH - Polk County Health

Department

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 49 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 50: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

2090 E. Clower St

Bartow, FL 33830

(863) 534-7258

Spanish, English

M-T 8am-5pm

W 7am-5pm, Th 8am-5pm,F 7am-5pm

# DN11009 Ebner, Stephen

NPI: 1578652442 LIC: DN11009

CERTIFICATIONS :

• Inhalation Sedation

# DN15480 Rodriguez, Ana

NPI: 1184835985 LIC: DN15480

CERTIFICATIONS :

• Inhalation Sedation

# DN19400 Santos, Luis

NPI: 1821152232 LIC: DN19400

CERTIFICATIONS :

• Inhalation Sedation

#CHC10107

DOH - Polk County Health

Department

3241 Lakeland Hills Blvd

Lakeland, FL 33805

(863) 519-7910

English, Spanish, Creoles and Pidgins,

French-based(other)

M-T 8am-5pm

W-F 8am-5pm

# DN11009 Ebner, Stephen

NPI: 1578652442 LIC: DN11009

CERTIFICATIONS :

• Inhalation Sedation

# DN15480 Rodriguez, Ana

NPI: 1184835985 LIC: DN15480

CERTIFICATIONS :

• Inhalation Sedation

# DN19400 Santos, Luis

NPI: 1821152232 LIC: DN19400

CERTIFICATIONS :

• Inhalation Sedation

#007727

Mulberry Dental Care, Inc

105 N. Church Ave

Mulberry, FL 33860

(863) 869-8888

English, Farsi, French, Persian (T),

Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN13817 Farzaneh, Masoud

NPI: 1669544540 LIC: DN13817

CERTIFICATIONS :

#022832

Ricardo Carlo Carrillo-Giraldo

1020 5Th Street Se

Winter Haven, FL 33880

(863) 299-2374

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN23339 Carrillo Giraldo, Ricardo

NPI: 1174979991 LIC: DN23339

CERTIFICATIONS :

ORAL SURGEON

#022551

Tampa Bay Institute of Oral

Surgery & Dental Implants

1301 Grasslands Blvd, Ste 200

Lakeland, FL 33803

(863) 648-6555

English, Spanish

M-T 7am-4pm

W-Th 7am-4pm

# DN18163 Aves, Renato

NPI: 1336322650 LIC: DN18163

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN23977 Elmohd, Tarik

NPI: 1538556329 LIC: DN23977

CERTIFICATIONS :

# DN21438 Kalsow, Oleg

NPI: 1275951972 LIC: DN21438

CERTIFICATIONS :

# DN19378 Samaniego, Juan

NPI: 1467692129 LIC: DN19378

CERTIFICATIONS :

• General Anesthesia

• Inhalation Sedation

# DN16473 Walcott, Sean

NPI: 1841250743 LIC: DN16473

CERTIFICATIONS :

• General Anesthesia

PUTNAM COUNTY

DENTIST

#FQHC010441

Azalea Health

2503 President Street

Palatka, FL 32177

(386) 328-7638

English, Spanish

M-T 8am-7pm

W-Th 8am-7pm

S 8am - 5pm

# DN21424 Budzinski, Volha

NPI: 1588047468 LIC: DN21424

CERTIFICATIONS :

# HAD56 Krotzinger, Mary

NPI: 1992796973 LIC: HAD56

CERTIFICATIONS :

# DN12941 Pairot, Alfredo

NPI: 1932174448 LIC: DN12941

CERTIFICATIONS :

#CHC10218

DOH - Putnam County Health

Department

2801 Kennedy Street

Palatka, FL 32177

(386) 326-3336

English, Spanish

M-T 8am-5pm

W 8am-6pm, Th 9am-6pm,F 8am-5pm

# DN18662 Williams, Richard

NPI: 1922231125 LIC: DN18662

CERTIFICATIONS :

SAINT JOHNS COUNTY

DENTIST

#FQHC016587

Azalea Health

250 State Rd 207

Saint Augustine, FL 32084

(904) 824-3322

English, Spanish

M-T 8am-7pm

W-Th 8am-7pm

# DN15770 Halady, Pratima

NPI: 1720256811 LIC: DN15770

CERTIFICATIONS :

SAINT LUCIE COUNTY

DENTIST

#FQHC020245

Florida Community Health

Centers, Inc.

1505 Delaware Ave

Fort Pierce, FL 34950

www.fchcinc.org

(772) 461-1402

English, Spanish, Creoles and Pidgins

(other)

M 8am - 6pm, T 8am - 8pm

W-F 8am-8pm

S 8am - 5pm

# DN14000 Naryshkin, George

NPI: 1730395773 LIC: DN14000

CERTIFICATIONS :

# DN18121 Palacios, Eric

NPI: 1376778084 LIC: DN18121

CERTIFICATIONS :

# DN17356 Saint Amand, Lynn

NPI: 1972655587 LIC: DN17356

CERTIFICATIONS :

# DN13771 Sanchez, Armando

NPI: 1992764930 LIC: DN13771

CERTIFICATIONS :

# DN13207 Zayas, Alida

NPI: 1639148968 LIC: DN13207

CERTIFICATIONS :

#014579

Happy Smiles

1100 Sw St. Lucie Blvd, Ste 206

Port Saint Lucie, FL 34986

happysmilespsl.com

(772) 807-1451

English, Russian, Creoles and Pidgins,

English-based(other), Hebrew,

Spanish

M 10am - 5pm, T 11am - 7pm

W 9am-5pm, Th 11am-7pm,F

9am-5pm

# DN20845 Bradley, Alijah

NPI: 1003224148 LIC: DN20845

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 50 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 51: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN10457 Broggi, Edward

NPI: 1215955190 LIC: DN10457

CERTIFICATIONS :

# DN24614 Cerrutti, Juan

NPI: 1992233167 LIC: DN24614

CERTIFICATIONS :

# DN24425 Faizzadeh, Paula

NPI: 1912550799 LIC: DN24425

CERTIFICATIONS :

# DN23511 Nguyen, Chi

NPI: 1811482656 LIC: DN23511

CERTIFICATIONS :

• Inhalation Sedation

# DN23454 Nguyen, Michelle

NPI: 1033603733 LIC: DN23454

CERTIFICATIONS :

• Inhalation Sedation

# DN24429 Shahriari, Varahram

NPI: 1952954778 LIC: DN24429

CERTIFICATIONS :

# DN16481 Zadov, Marianna

NPI: 1104903301 LIC: DN16481

CERTIFICATIONS :

• Inhalation Sedation

PERIODONTICS

# DN23115 Mendoza, Juan

NPI: 1821326430 LIC: DN23115

CERTIFICATIONS :

• Inhalation Sedation

# DN11699 Simon, David

NPI: 1508303587 LIC: DN11699

CERTIFICATIONS :

• Oral / Enteral Sedation

SARASOTA COUNTY

DENTIST

#015890

Beneva Dental Care

5917 S. Beneva Road

Sarasota, FL 34238

(941) 924-2939

English, Spanish

M 1pm - 5pm, T 9am - 2pm

W 1pm-5pm, Th 9am-2pm

# DN10922 Jimenez, Baltasar

NPI: 1104031442 LIC: DN10922

CERTIFICATIONS :

• Inhalation Sedation

#FQHC019492

CenterPlace Health Inc

1750 17Th St. Building E

Sarasota, FL 34236

(941) 529-0100

English, Spanish

M-T 7am-4pm

W-F 7am-4pm

# DN16242 Misischia, William

NPI: 1619199973 LIC: DN16242

CERTIFICATIONS :

• Inhalation Sedation

#FQHC019491

CenterPlace Health Inc.

6950 Outreach Way

North Port, FL 34287

(941) 529-0300

English, Spanish

M-T 7am-4pm

W-Th 7am-4pm

# DN21483 DeVilliers, Patricia

NPI: 1669568861 LIC: DN21483

CERTIFICATIONS :

• Inhalation Sedation

# DN23710 Houston, James

NPI: 1972661734 LIC: DN23710

CERTIFICATIONS :

• Inhalation Sedation

# DN14316 Jenkins, James

NPI: 1861701906 LIC: DN14316

CERTIFICATIONS :

• Inhalation Sedation

# DN16242 Misischia, William

NPI: 1619199973 LIC: DN16242

CERTIFICATIONS :

• Inhalation Sedation

#013443

F.A. Skordas, DDS, MS, PL

7129 Curtiss Ave, Ste #2

Sarasota, FL 34231

(941) 922-8811

English, Japanese

M-T 9am-5pm

W-Th 9am-5pm

S 8am - 3pm

# DN13645 Skordas, Fotios

NPI: 1124308812 LIC: DN13645

CERTIFICATIONS :

#022695

North Port Smiles

13801 Tamiami Trail, Ste B

North Port, FL 34287

(941) 200-5812

English

M-T 8am-5pm

W-F 8am-5pm

# DN7845 Carlow, Anna

NPI: 1962514596 LIC: DN7845

CERTIFICATIONS :

#022617

Velasquez-Pierce Family Dentistry

Inc

1872 S. Tamiami Trail, Ste E

Venice, FL 34293

(941) 497-4997

English, Spanish

M-T 8am-4pm

W-Th 8am-4pm

# DN21607 Velasquez-Pierce, Ximena

NPI: 1548606874 LIC: DN21607

CERTIFICATIONS :

SEMINOLE COUNTY

DENTIST

#009751

Altamonte Mall Dental

451 Altamonte Dr Ste, 1279

Altamonte Springs, FL 32701

(407) 261-0201

English, Russian, Spanish

M-T 8am-4pm

W-F 8am-4pm

# DN7894 Cullen, William

NPI: 1013110535 LIC: DN7894

CERTIFICATIONS :

• Inhalation Sedation

# DN23099 Rodriguez, Iveliss

NPI: 1962971200 LIC: DN23099

CERTIFICATIONS :

#012921

Amazing Smile, LLC

2417 S. French Ave

Sanford, FL 32771

(407) 321-5010

English, Spanish

M-T 9am-5pm

W-Th 9am-5pm

# DN20701 Clemente, Evelyn

NPI: 1952715443 LIC: DN20701

CERTIFICATIONS :

#CHC10026

DOH - Seminole County Health

Department

400 W. Airport Blvd

Sanford, FL 32773

(407) 665-3346

English, Arabic, Gujarati, Hindi,

Spanish

M-T 8am-5pm

W 8am-5pm, Th 8am-12pm,F

8am-5pm

# DN12474 Barinas, Norma

NPI: 1780690123 LIC: DN12474

CERTIFICATIONS :

# DN8976 Hanna, Nabil

NPI: 1215235924 LIC: DN8976

CERTIFICATIONS :

# HAD54 James, Frederick

NPI: 1861510984 LIC: HAD54

CERTIFICATIONS :

# DN18472 Koenig, Hans

NPI: 1760535934 LIC: DN18472

CERTIFICATIONS :

• Inhalation Sedation

#013496

Kush Dental LLC

1012 State Rd 436

Casselberry, FL 32707

(407) 636-7602

English, Spanish

M-T 8am-4pm

W 8am-4pm, Th 9am-5pm,F 9am-2pm

# DN12237 Figaro, Mark

NPI: 1952516965 LIC: DN12237

CERTIFICATIONS :

#FQHC019164

Orange Blossom Family Health

225 N. Kennel Road

Sanford, FL 32771

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 51 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 52: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

(407) 428-5751

English, Spanish, Chinese (T),

Creoles and Pidgins,

English-based(other), Hindi, Tagalog

# DN19583 Acosta, Edwin

NPI: 1578729711 LIC: DN19583

CERTIFICATIONS :

# DN19935 Keskar, Meghan

NPI: 1417205790 LIC: DN19935

CERTIFICATIONS :

# DN11833 Lim, Peter

NPI: 1821022526 LIC: DN11833

CERTIFICATIONS :

# DN23622 Pacheco, Magda

NPI: 1699264424 LIC: DN23622

CERTIFICATIONS :

SUMTER COUNTY

DENTIST

#015271

Central FL Dental Associates, LLC

11905 N Us Highway 301

Oxford, FL 34484

(352) 748-9688

English, Spanish

M-T 9am-5pm

W-F 9am-5pm

# DN12237 Figaro, Mark

NPI: 1952516965 LIC: DN12237

CERTIFICATIONS :

#FQHC10255

Langley Health Services

1389 S. U.S. Hwy 301

Sumterville, FL 33585

(352) 793-5900

English, Spanish

M-T 7am-6pm

W-F 7am-6pm

# DN19878 Clinton, Edna

NPI: 1376853929 LIC: DN19878

CERTIFICATIONS :

• Inhalation Sedation

# DN23356 Lutes, Meaghan

NPI: 1760974554 LIC: DN23356

CERTIFICATIONS :

# DN20142 Matthews, Irina

NPI: 1891135331 LIC: DN20142

CERTIFICATIONS :

# DN21667 Pirie, Edward

NPI: 1255705752 LIC: DN21667

CERTIFICATIONS :

# DN15250 Vavruska, Julie

NPI: 1992798649 LIC: DN15250

CERTIFICATIONS :

• Inhalation Sedation

SUWANNEE COUNTY

DENTIST

#012194

Smile Designs

530 E Howard St

Live Oak, FL 32064

(386) 362-6800

English, Spanish

M 9am - 5pm,

Th-F 9am-5pm

# DN14223 Gerry, Charlotte*

NPI: 1770789455 LIC: DN14223

CERTIFICATIONS :

TAYLOR COUNTY

DENTIST

#CHC10219

DOH - Taylor County Health

Department

1215 N. Peacock Ave

Perry, FL 32347

(850) 584-5087

English

M-T 7am-4pm

W-Th 7am-4pm

# DTC121 Woods, Stephanie

NPI: 1962465351 LIC: DTC121

CERTIFICATIONS :

#FQHC011463

Taylor Dental Center

616 S. Jefferson St

Perry, FL 32347

http://www.northfloridamedicalcenters.org

(850) 223-2578

English

M-T 8am-5pm

W-F 8am-5pm

# DN11230 Cherkinsky, Jordan

NPI: 1184637787 LIC: DN11230

CERTIFICATIONS :

# DN24185 Durham, Dominique

NPI: 1053972257 LIC: DN24185

CERTIFICATIONS :

VOLUSIA COUNTY

DENTIST

#011119

Ballet Dental Care

1857 Providence Blvd, Ste 200

Deltona, FL 32725

(321) 283-2850

English, Spanish

M-T 10am-5pm

W-F 10am-5pm

# DN16520 Ballet, Lourdes

NPI: 1255517850 LIC: DN16520

CERTIFICATIONS :

#FQHC020653

Family Health Source

1205 Woodland Blvd, Ste 5

Deland, FL 32720

(386) 888-4911

English, Spanish

M-T 8am-5pm

W-Th 8am-5pm

# DN12417 Torres, Leonel

NPI: 1942411962 LIC: DN12417

CERTIFICATIONS :

WAKULLA COUNTY

DENTIST

#CHC013453

DOH - Wakulla County Health

Department

48 Oak Street

Crawfordville, FL 32327

(850) 926-0400

English

M 6am - 4pm, T 7am - 4pm

W-Th 6am-4pm

# DTC121 Woods, Stephanie

NPI: 1962465351 LIC: DTC121

CERTIFICATIONS :

WALTON COUNTY

DENTIST

#012992

LECOM School of Dental

Medicine - Dental Offices

101 Lecom Way

Defuniak Springs, FL 32435

(850) 951-0200

English

M-T 7am-7pm

W-F 7am-7pm

# DN6824 Henry, Dan

NPI: 1932279122 LIC: DN6824

CERTIFICATIONS :

• Inhalation Sedation

# DN14491 Turner, Helen

NPI: 1518049717 LIC: DN14491

CERTIFICATIONS :

# DN6012 Zieman, Stephen

NPI: 1407100720 LIC: DN6012

CERTIFICATIONS :

#FQHC010686

PanCare of Florida, Inc.

479 E. Hwy 20

Freeport, FL 32439

(850) 880-6568

English

M-T 8am-5pm

W-F 8am-5pm

# DN19128 Claussen, Meghann

NPI: 1336454651 LIC: DN19128

CERTIFICATIONS :

# DN13094 Hudon, Richard

NPI: 1245336031 LIC: DN13094

CERTIFICATIONS :

# DN22620 Knowles, Laura

NPI: 1346778412 LIC: DN22620

CERTIFICATIONS :

# DN23419 Lindsay, Sean

NPI: 1477046290 LIC: DN23419

CERTIFICATIONS :

# DN21740 Moffa, Michelle

NPI: 1841277407 LIC: DN21740

CERTIFICATIONS :

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 52 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 53: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

# DN19745 Norton, Andrew

NPI: 1861754020 LIC: DN19745

CERTIFICATIONS :

# HAD73 Pankuch, Richard

NPI: 1467452847 LIC: HAD73

CERTIFICATIONS :

# DN21660 Piorkowski, Gary

NPI: 1699705434 LIC: DN21660

CERTIFICATIONS :

# HAD69 Smith, Amy

NPI: 1831209899 LIC: HAD69

CERTIFICATIONS :

# HAD65 Wilhite, Rhonda

NPI: 1952496341 LIC: HAD65

CERTIFICATIONS :

ORAL SURGEON

#012992

LECOM School of Dental

Medicine - Dental Offices

101 Lecom Way

Defuniak Springs, FL 32435

(850) 951-0200

English

M-T 7am-7pm

W-F 7am-7pm

# DN12590 Elwell, Charles

NPI: 1932174356 LIC: DN12590

CERTIFICATIONS :

• Board Certification

• General Anesthesia

PERIODONTICS

# DN4547 Couch, Deck

NPI: 1417190950 LIC: DN4547

CERTIFICATIONS :

WASHINGTON COUNTY

DENTIST

#CHC015270

DOH - Washington County Health

Department

1338 South Blvd

Chipley, FL 32428

(850) 638-6240

English

M-T 7am-5pm

W-Th 7am-5pm

# DN18661 Whitford, Drew

NPI: 1851527303 LIC: DN18661

CERTIFICATIONS :

• Inhalation Sedation

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 53 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.

Page 54: FLORIDA MEDICAID ADULT - LIBERTY Dental Plan · Member Services / Servicios para miembros : (833) 276-0850 FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES ALACHUA

Member Services / Servicios para miembros : (833) 276-0850

FLORIDA MEDICAID ADULT

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Availability of Language Assistance Services

LIBERTY makes certain language assistance services available to you at no cost. If English is not your preferred language and you need

help communicating in your preferred language, you may call 833-276-0850 to ask what language services are available to you.

Enrollees with Disabilities

As a LIBERTY enrollee (including enrollees with disabilities), you have full and equal access to covered services as required under the

federal Americans with Disabilities Act of 1990 and Section 504 of the Rehabilitation Act of 1973.

Directory Information

Did you find information that you think may need to be updated in our provider directories? Please let us know, so we can review it.

Phone: 833-276-0850 Email: [email protected]

Specialist Information

Your plan may only provide benefits if you obtain a referral from your General Dentist prior to receiving treatment from a Specialist. Please

refer to your Evidence of Coverage prior to contacting a Specialist if you are unsure, or call Member Services.

In accordance with s. 1932(b)(3) of the Social Security Act

Providers may choose not to perform certain services based on religious or moral beliefs.

Requesting a current List of Providers

If you need a current listing of providers, you can find one at www.libertydentalplan.com/FLMedicaid or you may request one by calling our

Member Services Department toll-free at 833-276-0850.

LIBERTY Dental Plan network provider rating is based on quality measures and service.

Overall ratings range from 1 star to 5 stars, with the more stars shows higher quality.

The provider directory is subject to change without notice.

Languages spoken by the offices are reported. The languages are not verified by LIBERTY Dental Plan.

If you need to access LIBERTY’s free interpretation services please call the number listed on your ID card.

To view current providers, please visit our website, www.libertydentalplan.com/FLMedicaid.

El directorio de proveedores está sujeto a cambios sin previo aviso.

Los idiomas que se hablan en las oficinas seran reportados. Los idiomas no son verificados por LIBERTY Dental Plan.

Si necesita usar los servicios gratuitos de interpretación de LIBERTY, llame al número que aparece en su tarjeta de identificación.

Para ver los proveedores actuales, visite nuestro sitio web, www.libertydentalplan.com/FLMedicaid.

* Closed to new members / Cerrado para nuevos miembros. Page 54 of 54

February, 2020

02/10/2020 v.1(2018)

Wheelchair access / Acceso para personas en silla de ruedas.