FLORIDA MEDICAID CHILD - LIBERTY Dental Plan

FLORIDA MEDICAID CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

ALACHUA COUNTY

DENTIST

# RHC010936

Acorn Clinic

23320 N State Road 235 Brooker, FL 32622

(352) 485-2772 Special Needs: Yes English, Spanish, Gujarati M-T 8am - 3:30 pm # DN18987 Bhakta, Paayal

NPI: 1033439823 LIC: DN18987 # DN9374 Hsiung, Edwin

NPI: 1417389586 LIC: DN9374 # DN21295 Luaces, Olga

NPI: 1407237555 LIC: DN21295

M-T 8am - 5pm W-F 8am - 5pm

# DN25141FL Le, Lynn NPI: 1336750470 LIC: DN25141FL

# DN20873 Lopez, Melvin General Dentist servicing as: Pediatric Dentistry NPI: 1689081242 LIC: DN20873

# DN20946FL Nguyen, David NPI: 1811398423 LIC: DN20946FL

# DN12941 Pairot, Alfredo General Dentist servicing as: Pediatric Dentistry NPI: 1932174448 LIC: DN12941

# DN20886 Wells, Rachelle General Dentist servicing as: Pediatric Dentistry NPI: 1588858286 LIC: DN20886

CERTIFICATIONS: ? Inhalation Sedation

# EV1081165

Agency for Person's with Disabilities - Tacachale

1621 Ne Waldo Road Gainesville, FL 32609 cachale/

(352) 955-5665 Special Needs: Yes English, Spanish M-T 8am - 5pm W-F 8am - 5pm

# DN8807 Garvey, Timothy* NPI: 1205892296 LIC: DN8807

# FQHC010440

Aza Health

410 Ne Waldo Rd Gainesville, FL 32641

(352) 375-3790 Special Needs: Yes English, Spanish

# CHC014623

DOH - Alachua County Health Department

816 Sw 64Th Terrance Gainesville, FL 32607

(352) 334-8839 Special Needs: Yes English, Russian, Bulgarian, German, Italian, Spanish M-T 8am - 5pm W-F 8am - 5pm

# DN21933 Vu, Clara General Dentist servicing as: Pediatric Dentistry NPI: 1235589482 LIC: DN21933

CERTIFICATIONS: ? Inhalation Sedation

# CHC017031

DOH - Alachua County Health Department

224 Se 24 St

Gainesville, FL 32641 (352) 334-8839

Special Needs: No English, Spanish M-T 8am - 5pm W-F 8am - 5pm # DN21933 Vu, Clara

General Dentist servicing as: Pediatric Dentistry NPI: 1235589482 LIC: DN21933 CERTIFICATIONS: ? Inhalation Sedation

# 010755

University of Florida College of Dentistry

1600 Sw Archer Rd Gainesville, FL 32610 dental.ufl.edu

(352) 273-6701 Special Needs: Yes English, Other M-T 8am - 5pm W-F 8am - 5pm # DN14714 Barnes, David

NPI: 1467667451 LIC: DN14714 # DN24628FL Bauman, Eric

NPI: 1114017209 LIC: DN24628FL # DN7077 Benjamin, Paul

NPI: 1225057128 LIC: DN7077 # DN16284 Borders, Kelley

NPI: 1043355522 LIC: DN16284 # DTP796 Commean, Mark

NPI: 1891872958 LIC: DTP796 # DN8382 Cook, Larry

NPI: 1902813777 LIC: DN8382 # DN20352FL Corasro, Andrew

NPI: 1144656232 LIC: DN20352FL # DTP743 Daher Achi, Astrid

NPI: 1053870931 LIC: DTP743 # DTP603 Delgado, Alejandro

NPI: 1669887485 LIC: DTP603 # DTP747 Denton, Scott

NPI: 1740389147 LIC: DTP747 # DTP639 Dias Ribeiro, Ana

NPI: 1053860924 LIC: DTP639 # DN13471 Dilbone, Deborah

NPI: 1104882497 LIC: DN13471 # DN21973 Fields, Kyle

NPI: 1871048157 LIC: DN21973 # DN8807 Garvey, Timothy

NPI: 1205892296 LIC: DN8807 # DTP710 Gohel, Rajendra

NPI: 1912071754 LIC: DTP710 # DN18643 Grant, Vanisia

NPI: 1689801177 LIC: DN18643 # DN7710 Haddix, James

NPI: 1336105709 LIC: DN7710 # DTP672 Haddock, Fernando

NPI: 1477531234 LIC: DTP672 # DTP731 Hosney, Sherif

NPI: 1215515515 LIC: DTP731 # DTP783 Hussein, Hind

NPI: 1386341832 LIC: DTP783 # DN9870 Kaleel, Nicholas

NPI: 1447258991 LIC: DN9870 # DTP746 Kouveliotis, Georgios*

NPI: 1457023996 LIC: DTP746 # DN21295 Luaces, Olga

NPI: 1407237555 LIC: DN21295 # DTP659 Migliorati, Cesar

General Dentist servicing as: Endodontics NPI: 1992810519 LIC: DTP659 CERTIFICATIONS: ? Inhalation Sedation # DTP497 Nascimento, Marcelle NPI: 1275706426 LIC: DTP497 # DTP702 Oliveira, Dayane

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, FLMedicaid.

El directorio de proveedores est? 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 interpretaci?n de LIBERTY, llame al n?mero que aparece en su tarjeta de identificaci?n.

Para ver los proveedores actuales, visite nuestro sitio web, FLMedicaid.

March, 2024

* Closed to new members / Cerrado para nuevos miembros.

Wheelchair access / Acceso para personas en silla de ruedas.

Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y d?as festivos solo con cita previa.

Page 1 of 256

03/01/2024 v2(2020)

FLORIDA MEDICAID CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1487204178 LIC: DTP702

Gainesville, FL 32605

# DN8944 Ottenga, Marc NPI: 1306802293 LIC: DN8944

CERTIFICATIONS: ? Inhalation Sedation

# DTP612 Pereira, Patricia NPI: 1437535218 LIC: DTP612

# DN21168 Pocola, Eduard NPI: 1134510068 LIC: DN21168

(352) 375-7776

Special Needs: No English, Spanish, French M-T 8am - 5pm W-Th 8am - 5pm

# DN24834FL Jordan-Gonzalez, Michelle

NPI: 1689192627 LIC: DN24834FL

# DTP683 Reis, Andre NPI: 1891278768 LIC: DTP683

# DN23014 Natera-Fernandez, Marianella

# DN14930 Rey, Rosalia

NPI: 1073061297 LIC: DN23014

NPI: 1346341443 LIC: DN14930 # DTP490 Ribeiro-DaSilva, Margarete

NPI: 1326228321 LIC: DTP490 # DTP703 Rocha, Mateus

# 010755

University of Florida College of Dentistry

1600 Sw Archer Rd Gainesville, FL 32610

NPI: 1376193060 LIC: DTP703

dental.ufl.edu

# DTP562 Roulet, Jean-Francois NPI: 1831539816 LIC: DTP562

# DN24076 Savioli, Cynthia NPI: 1336677756 LIC: DN24076

(352) 273-6701 Special Needs: Yes English, Other M-T 8am - 5pm W-F 8am - 5pm

# DTP669 Sikand, Rebecca

# DTP654 Bakiri, Eleonora

NPI: 1942654546 LIC: DTP669

NPI: 1952834418 LIC: DTP654

# DTP645 Silva, Maria

# DN14544 Cerrud, Clinio

NPI: 1932452547 LIC: DTP645

NPI: 1629184676 LIC: DN14544

# DN20154 Sley, Allison* NPI: 1649619347 LIC: DN20154

# DN27352 Smallwood, Bryan NPI: 1609513787 LIC: DN27352

# DN22024 Terza, Stephanni NPI: 1588014591 LIC: DN22024

CERTIFICATIONS: ? Inhalation Sedation

# DTP450 Pileggi, Roberta NPI: 1356393821 LIC: DTP450

CERTIFICATIONS: ? Inhalation Sedation ? Board Certification

ENDODONTICS

# DTP748 Soares Leibovitch, Indala

# 022671

NPI: 1770245011 LIC: DTP748

North Central Florida

ORAL SURGEON

Endodontics

4881 Nw 8Th Ave Ste 3

# DTP800 Bhula, Avni

NPI: 1174112288 LIC: DTP800 # DTP787 Buschman, Jason

NPI: 1891720728 LIC: DTP787 # DTP232 Dolwick, Melvin

NPI: 1659337590 LIC: DTP232 CERTIFICATIONS:

? Inhalation Sedation ? Board Certification

# DTP664 Freburg-Hoffmeister, Danielle

NPI: 1447545132 LIC: DTP664 CERTIFICATIONS:

? Inhalation Sedation

# DTP709 Gohel, Anita NPI: 1841563947 LIC: DTP709

# DN12910 Hardeman, John NPI: 1447343918 LIC: DN12910

CERTIFICATIONS: ? Inhalation Sedation ? General Anesthesia ? Board Certification

# DTP761 Nessif, Richard NPI: 1497086342 LIC: DTP761

# DTP741FL Pahadia, Mayank NPI: 1861065948 LIC: DTP741FL

ORTHODONTIST

# DTP760 Abu Arqub, Sarah NPI: 1043770704 LIC: DTP760

# DN13393 Dolce, Calogero NPI: 1881650331 LIC: DN13393

CERTIFICATIONS: ? Board Certification

# DTP715FL Karanth Huttinagadde, Divakar

NPI: 1164049458 LIC: DTP715FL # DT394 Neubert, John

NPI: 1760448989 LIC: DT394

PEDIATRIC DENTISTRY

# RHC010936

Acorn Clinic

23320 N State Road 235 Brooker, FL 32622

(352) 485-2772 Special Needs: Yes English, Spanish, Gujarati M-T 8am - 3:30 pm

# DTP720 Carey, Teemar NPI: 1538549951 LIC: DTP720

# DN18234 Perez, Edna NPI: 1962536714 LIC: DN18234

CERTIFICATIONS: ? Inhalation Sedation ? Board Certification

# 010755

University of Florida College of Dentistry

1600 Sw Archer Rd Gainesville, FL 32610 dental.ufl.edu

(352) 273-6701 Special Needs: Yes English, Other M-T 8am - 5pm W-F 8am - 5pm

# DTP437 Adewumi, Abimbola* NPI: 1285690636 LIC: DTP437

CERTIFICATIONS: ? Inhalation Sedation ? Board Certification

# DTP720 Carey, Teemar* NPI: 1538549951 LIC: DTP720

# DN22995 Connell, Christopher NPI: 1689125742 LIC: DN22995

CERTIFICATIONS: ? Inhalation Sedation

# DTP418 Guelmann, Marcio NPI: 1972568848 LIC: DTP418

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, FLMedicaid.

El directorio de proveedores est? 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 interpretaci?n de LIBERTY, llame al n?mero que aparece en su tarjeta de identificaci?n.

Para ver los proveedores actuales, visite nuestro sitio web, FLMedicaid.

March, 2024

* Closed to new members / Cerrado para nuevos miembros.

Wheelchair access / Acceso para personas en silla de ruedas.

Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y d?as festivos solo con cita previa.

Page 2 of 256

03/01/2024 v2(2020)

FLORIDA MEDICAID CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

? Inhalation Sedation ? Board Certification

# DTP802 Lee, Mi Sook NPI: 1821578758 LIC: DTP802

# DN18234 Perez, Edna NPI: 1962536714 LIC: DN18234

CERTIFICATIONS: ? Inhalation Sedation ? Board Certification

PERIODONTICS

# DTP606 Chang, Jia NPI: 1871862029 LIC: DTP606

# DTP687 Duarte Reis, Poliana NPI: 1619448677 LIC: DTP687

# DTP638 Duarte, Wagner NPI: 1407305022 LIC: DTP638

# DN21876 Schey, Karin NPI: 1285086173 LIC: DN21876

PROSTHODONTICS

# DTP784 Abdulhameed, Nader NPI: 1457701914 LIC: DTP784

# DTP756 Albuquerque Garcia, Bruna

NPI: 1326780396 LIC: DTP756 # DTP722FL Cabrera da Silva, Alexandre

NPI: 1962004408 LIC: DTP722FL # DTP467 Esquivel-Upshaw, Josephine

NPI: 1760495527 LIC: DTP467 # DTP788 Shivaraman, Visalakshi

NPI: 1588345607 LIC: DTP788 # DTP653 Zoidis, Panagiotis

NPI: 1871020495 LIC: DTP653

BAKER COUNTY

DENTIST

# CHC013141

DOH - Baker County Health Department

English, Spanish, Hindi, Punjabi, Urdu M-T 7:30 am - 4:30 pm W-F 7:30 am - 4:30 pm

480 W Lowder St

# DN11663 Bridges, Catherine

Macclenny, FL 32063 baker.web@

(904) 259-9815 Special Needs: Yes English M-T 8am - 5pm # DN11663 Bridges, Catherine

NPI: 1659309821 LIC: DN11663

# DTC18 Burgos-Polo, Jose

NPI: 1659309821 LIC: DN11663

# DN21103 Ghani, Rehan NPI: 1316333230 LIC: DN21103

CERTIFICATIONS: ? Inhalation Sedation

# DN11385 Traul Jr., Robert General Dentist servicing as: Endodontics NPI: 1982734257 LIC: DN11385

NPI: 1013903996 LIC: DTC18

# DN11888 Hackney, Tara NPI: 1710953765 LIC: DN11888

# 010672

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

CERTIFICATIONS:

2624 Jenks Ave

? Inhalation Sedation

Panama City, FL 32405

# DN25334 Nguyen-Tran, Mykhue

(850) 215-0798

NPI: 1891306213 LIC: DN25334

Special Needs: Yes

# DN18785 Patel, Viral

English

NPI: 1881917540 LIC: DN18785

M-T 8am - 3pm

CERTIFICATIONS:

Th-F 8am - 3pm

? Inhalation Sedation

# DN11385 Traul Jr., Robert General Dentist servicing as: Endodontics NPI: 1982734257 LIC: DN11385

BAY COUNTY

# DN17200 Fleigel III, Jeffrey* NPI: 1336357748 LIC: DN17200

CERTIFICATIONS: ? Board Certification

# FQHC010683

PanCare of Florida, Inc.

DENTIST

# CHC10280

DOH - Bay County Health Department

3518 E. 15Th St Panama City, FL 32404

(850) 872-4455 Special Needs: Yes

403 E 11Th St Panama City, FL 32401

(850) 767-3350 Special Needs: Yes English, Spanish M-T 8am - 5pm W-F 8am - 5pm

# DN10365FL Barry, Steven NPI: 1497826531 LIC: DN10365FL

# DN19128 Claussen, Meghann NPI: 1336454651 LIC: DN19128

# DN25097 Haynam, Eric NPI: 1043688831 LIC: DN25097

# DN18668 Isaac, Kanyaratana NPI: 1003122656 LIC: DN18668

# DN21740 Moffa, Michelle General Dentist servicing as: NPI: 1841277407 LIC: DN21740

# DN19745 Norton, Andrew NPI: 1861754020 LIC: DN19745

# DN18871 Pate, Sheena General Dentist servicing as: NPI: 1215255880 LIC: DN18871

# DN21660 Piorkowski, Gary General Dentist servicing as: NPI: 1699705434 LIC: DN21660

# DN23084 Santos, Iris NPI: 1487875233 LIC: DN23084

# HAD69 Smith, Amy NPI: 1831209899 LIC: HAD69

# HAD65 Wilhite, Rhonda General Dentist servicing as: Oral Surgery NPI: 1952496341 LIC: HAD65

# FQHC022012

PanCare of Florida, Inc.

12427 Hwy 231 Youngstown, FL 32466

(850) 753-3246 Special Needs: Yes English, Spanish M-T 8am - 5pm W-F 8am - 5pm # DN10365FL Barry, Steven

NPI: 1497826531 LIC: DN10365FL # DN19128 Claussen, Meghann

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, FLMedicaid.

El directorio de proveedores est? 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 interpretaci?n de LIBERTY, llame al n?mero que aparece en su tarjeta de identificaci?n.

Para ver los proveedores actuales, visite nuestro sitio web, FLMedicaid.

March, 2024

* Closed to new members / Cerrado para nuevos miembros.

Wheelchair access / Acceso para personas en silla de ruedas.

Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y d?as festivos solo con cita previa.

Page 3 of 256

03/01/2024 v2(2020)

FLORIDA MEDICAID CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1336454651 LIC: DN19128 # DN25097 Haynam, Eric

NPI: 1043688831 LIC: DN25097 # DN21740 Moffa, Michelle

General Dentist servicing as: NPI: 1841277407 LIC: DN21740 # DN19745 Norton, Andrew NPI: 1861754020 LIC: DN19745 # DN18871 Pate, Sheena General Dentist servicing as: NPI: 1215255880 LIC: DN18871 # DN23084 Santos, Iris NPI: 1487875233 LIC: DN23084 # HAD69 Smith, Amy NPI: 1831209899 LIC: HAD69 # HAD65 Wilhite, Rhonda General Dentist servicing as: Oral Surgery NPI: 1952496341 LIC: HAD65

# 014966

Royal Dental

2335 State Ave Ste A Panama City, FL 32405

(850) 740-3100 Special Needs: Yes English, Arabic, Spanish M-T 8am - 5pm W-Th 8am - 5pm # DN21598 Abdulrahim, Yahia

General Dentist servicing as: NPI: 1184092603 LIC: DN21598

ORAL SURGEON

# 010672

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

2624 Jenks Ave Panama City, FL 32405

(850) 215-0798 Special Needs: Yes English M-T 8am - 3pm Th-F 8am - 3pm # DN24725 Brinker, Matthew*

NPI: 1033567367 LIC: DN24725 # DN17080 Claussen, Eric*

NPI: 1194983965 LIC: DN17080 CERTIFICATIONS:

? Inhalation Sedation ? General Anesthesia

# DN23806 Long, Larry* NPI: 1275527137 LIC: DN23806

ORTHODONTIST

# 011426

Advanced Orthodontics

2202 State Ave Panama City, FL 32405

(850) 296-8665 Special Needs: Yes English M-T 7:30 am - 5pm # DN19214 Kovaleski, Lauren

NPI: 1366754558 LIC: DN19214 # DN10667 Wheeler, Timothy

NPI: 1558328153 LIC: DN10667 CERTIFICATIONS:

? Board Certification

PEDIATRIC DENTISTRY

# 010734

Panhandle Pediatric Dentistry, PLLC

3123 W 23Rd St Panama City, FL 32405 panhandlepediatricdentistry .com

(850) 481-1969 Special Needs: Yes English M-T 8:30 am - 4:30 pm W-Th 8:30 am - 4:30 pm # DN16280 Berry, Stephen Eric

NPI: 1699889352 LIC: DN16280 CERTIFICATIONS:

? Pediatric Conscious Sedation ? Inhalation Sedation ? Board Certification

# DN23156 Fujawa, Douglas NPI: 1336541135 LIC: DN23156

CERTIFICATIONS: ? Inhalation Sedation

# DN23264 Johnson, Patrick NPI: 1770932402 LIC: DN23264

CERTIFICATIONS: ? Inhalation Sedation

# DN20298 Lapointe, Lisa NPI: 1336454701 LIC: DN20298

CERTIFICATIONS: ? Pediatric Conscious Sedation ? Inhalation Sedation ? Board Certification

# DN22673 Thomas, Michelle NPI: 1710408455 LIC: DN22673

BREVARD COUNTY

DENTIST

# FQHC011681

Brevard Health Alliance

2120 Sarno Rd Melbourne, FL 32935

(321) 241-6800 Special Needs: Yes English, Spanish M-T 8am - 6pm W-Th 8am - 6pm # HAD82 Alongi, Jennifer*

General Dentist servicing as: Pediatric Dentistry

NPI: 1306139019 LIC: HAD82 CERTIFICATIONS:

? Inhalation Sedation

# DN22332 Baddour, Mary* NPI: 1730630633 LIC: DN22332

# HAD127 Baez, Zoila* NPI: 1164498986 LIC: HAD127

# DN14021 Cheshire, Gregory* General Dentist servicing as: Pediatric Dentistry NPI: 1952303059 LIC: DN14021

CERTIFICATIONS: ? Inhalation Sedation

# HAD118 Fife, John* General Dentist servicing as: Oral Surgery NPI: 1609427947 LIC: HAD118

# DN25385 Hicks, Michael* NPI: 1407347107 LIC: DN25385

# HAD16 Kormann, Jacqueline* General Dentist servicing as: Pediatric Dentistry NPI: 1346214889 LIC: HAD16

# HAD128 Lim, Amalou* NPI: 1508869876 LIC: HAD128

# HAD116 Mintz, Talya* NPI: 1255418588 LIC: HAD116

# HAD126 Rule, Lindsay* NPI: 1033471255 LIC: HAD126

# DN20658 Smith, Ross* General Dentist servicing as: Pediatric Dentistry NPI: 1245626811 LIC: DN20658

CERTIFICATIONS: ? Inhalation Sedation

# DN25324 Wilson, Shayla* NPI: 1689239691 LIC: DN25324

# FQHC011682

Brevard Health Alliance

220 Barton Blvd, Unit C14

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, FLMedicaid.

El directorio de proveedores est? 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 interpretaci?n de LIBERTY, llame al n?mero que aparece en su tarjeta de identificaci?n.

Para ver los proveedores actuales, visite nuestro sitio web, FLMedicaid.

March, 2024

* Closed to new members / Cerrado para nuevos miembros.

Wheelchair access / Acceso para personas en silla de ruedas.

Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y d?as festivos solo con cita previa.

Page 4 of 256

03/01/2024 v2(2020)

FLORIDA MEDICAID CHILD

PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Rockledge, FL 32955

(321) 639-5177 Special Needs: Yes English, Spanish M-T 8am - 6pm W-Th 8am - 6pm # HAD82 Alongi, Jennifer*

General Dentist servicing as: Pediatric Dentistry NPI: 1306139019 LIC: HAD82 CERTIFICATIONS: ? Inhalation Sedation # DN22332 Baddour, Mary* NPI: 1730630633 LIC: DN22332

# HAD127 Baez, Zoila* NPI: 1164498986 LIC: HAD127

# DN14021 Cheshire, Gregory* General Dentist servicing as: Pediatric Dentistry NPI: 1952303059 LIC: DN14021

CERTIFICATIONS: ? Inhalation Sedation

# HAD118 Fife, John* General Dentist servicing as: Oral Surgery NPI: 1609427947 LIC: HAD118

# DN25385 Hicks, Michael* NPI: 1407347107 LIC: DN25385

# HAD16 Kormann, Jacqueline* General Dentist servicing as: Pediatric Dentistry NPI: 1346214889 LIC: HAD16

# HAD128 Lim, Amalou* NPI: 1508869876 LIC: HAD128

# HAD116 Mintz, Talya* NPI: 1255418588 LIC: HAD116

# HAD126 Rule, Lindsay* NPI: 1033471255 LIC: HAD126

# DN20658 Smith, Ross*

General Dentist servicing as: Pediatric Dentistry NPI: 1245626811 LIC: DN20658 CERTIFICATIONS: ? Inhalation Sedation # DN25324 Wilson, Shayla* NPI: 1689239691 LIC: DN25324

# FQHC016241

Brevard Health Alliance

7227 N. Us Hwy 1 Cocoa, FL 32927

(321) 877-2740 Special Needs: Yes English, Spanish M-T 8am - 6pm W-Th 8am - 6pm # HAD82 Alongi, Jennifer*

General Dentist servicing as: Pediatric Dentistry NPI: 1306139019 LIC: HAD82 CERTIFICATIONS: ? Inhalation Sedation # DN22332 Baddour, Mary* NPI: 1730630633 LIC: DN22332

# HAD127 Baez, Zoila* NPI: 1164498986 LIC: HAD127

# DN14021 Cheshire, Gregory* General Dentist servicing as: Pediatric Dentistry NPI: 1952303059 LIC: DN14021

CERTIFICATIONS: ? Inhalation Sedation

# HAD118 Fife, John* General Dentist servicing as: Oral Surgery NPI: 1609427947 LIC: HAD118

# DN25385 Hicks, Michael* NPI: 1407347107 LIC: DN25385

# HAD16 Kormann, Jacqueline* General Dentist servicing as: Pediatric Dentistry

NPI: 1346214889 LIC: HAD16

# HAD128 Lim, Amalou* NPI: 1508869876 LIC: HAD128

# HAD116 Mintz, Talya* NPI: 1255418588 LIC: HAD116

# HAD126 Rule, Lindsay* NPI: 1033471255 LIC: HAD126

# DN20658 Smith, Ross* General Dentist servicing as: Pediatric Dentistry NPI: 1245626811 LIC: DN20658

CERTIFICATIONS: ? Inhalation Sedation

# DN25324 Wilson, Shayla* NPI: 1689239691 LIC: DN25324

# FQHC021352

Brevard Health Alliance

5270 Babcock Street Ne Ste #1 Palm Bay, FL 32905

(321) 722-5959 Special Needs: Yes Spanish, English M-T 8am - 6pm W-Th 8am - 6pm # HAD82 Alongi, Jennifer*

General Dentist servicing as: Pediatric Dentistry NPI: 1306139019 LIC: HAD82 CERTIFICATIONS: ? Inhalation Sedation # DN22332 Baddour, Mary* NPI: 1730630633 LIC: DN22332

# DN14021 Cheshire, Gregory* General Dentist servicing as: Pediatric Dentistry NPI: 1952303059 LIC: DN14021

CERTIFICATIONS: ? Inhalation Sedation

# DN25385 Hicks, Michael* NPI: 1407347107 LIC: DN25385

# HAD116 Mintz, Talya* NPI: 1255418588 LIC: HAD116

# DN20658 Smith, Ross* General Dentist servicing as: Pediatric Dentistry NPI: 1245626811 LIC: DN20658

CERTIFICATIONS: ? Inhalation Sedation

# DN25324 Wilson, Shayla* NPI: 1689239691 LIC: DN25324

# FQHC021353

Brevard Health Alliance

775 Malabar Road Ste #105 Malabar, FL 32950

(321) 733-0642 Special Needs: Yes English, Spanish M-T 8am - 5pm W-F 8am - 5pm # HAD82 Alongi, Jennifer*

General Dentist servicing as: Pediatric Dentistry NPI: 1306139019 LIC: HAD82 CERTIFICATIONS: ? Inhalation Sedation # DN22332 Baddour, Mary* NPI: 1730630633 LIC: DN22332

# DN14021 Cheshire, Gregory* General Dentist servicing as: Pediatric Dentistry NPI: 1952303059 LIC: DN14021

CERTIFICATIONS: ? Inhalation Sedation

# DN25385 Hicks, Michael* NPI: 1407347107 LIC: DN25385

# HAD116 Mintz, Talya* NPI: 1255418588 LIC: HAD116

# DN20658 Smith, Ross* General Dentist servicing as: Pediatric Dentistry NPI: 1245626811 LIC: DN20658

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, FLMedicaid.

El directorio de proveedores est? 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 interpretaci?n de LIBERTY, llame al n?mero que aparece en su tarjeta de identificaci?n.

Para ver los proveedores actuales, visite nuestro sitio web, FLMedicaid.

March, 2024

* Closed to new members / Cerrado para nuevos miembros.

Wheelchair access / Acceso para personas en silla de ruedas.

Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y d?as festivos solo con cita previa.

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