FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

M-T 8am - 5pm • Inhalation Sedation ALACHUA COUNTY # FQHC010440 W-F 8am - 5pm # 011246 Aza Health # DN21933 Vu, Clara* DENTIST Gainesville Dental Center 410 Ne Waldo Road General Dentist servicing as: Gainesville, FL 32641 4000 West Newberry Road, Ste # RHC010936 Pediatric Dentistry (352) 375-3790 NPI: 1235589482 LIC: DN21933 E Acorn Clinic Gainesville, FL 32607 Special Needs: Yes CERTIFICATIONS: 23320 N. State Rd, Ste 235 English, Spanish • Inhalation Sedation (352) 378-3131 Brooker, FL 32622 M-T 8am - 5pm Special Needs: Yes (352) 485-2772 W-F 8am - 5pm # CHC017031 English, Arabic Special Needs: Yes DOH - Alachua County M-T 9am - 5pm # DN15770 Halady, Pratima English, Spanish, Gujarati General Dentist servicing as: Health Department # DN9531 Attia, Safwat* M-T 8am - 4pm Pediatric Dentistry 224 Se 24Th St NPI: 1952311730 LIC: DN9531 W-Th 8am - 4pm NPI: 1720256811 LIC: DN15770 Gainesville, FL 32641 # DN8024 Aguirre, Michael (352) 334-8839 # 010755 # DN25141FL Le, Lynn NPI: 1740388800 LIC: DN8024 Special Needs: Yes University of Florida College NPI: 1336750470 LIC: DN25141FL English, Spanish # DN18987 Bhakta, Paayal of Dentistry # DN20873 Lopez, Melvin M-T 8am - 5pm 1600 Sw Archer Road NPI: 1033439823 LIC: DN18987 General Dentist servicing as: W-F 8am - 5pm Gainesville, FL 32610 # DN9374 Hsiung, Edwin Pediatric Dentistry # DN19484 Jones, Stephanie* www.dental.ufl.edu NPI: 1417389586 LIC: DN9374 NPI: 1689081242 LIC: DN20873 NPI: 1548549678 LIC: DN19484 (352) 273-6731 # DN19484 Jones, Stephanie # DN16033FL Nguyen, Daniel Special Needs: Yes # DN21933 Vu, Clara* NPI: 1134238892 LIC: DN16033FL English, Other NPI: 1548549678 LIC: DN19484 General Dentist servicing as: M-T 8am - 5pm # DN21295 Luaces, Olga # DN20946FL Nguyen, David Pediatric Dentistry W-F 8am - 5pm NPI: 1407237555 LIC: DN21295 NPI: 1811398423 LIC: DN20946FL NPI: 1235589482 LIC: DN21933 CERTIFICATIONS: # DN14714 Barnes, David # DN6188 Witt, William # DN12941 Pairot, Alfredo • Inhalation Sedation NPI: 1467667451 LIC: DN14714 NPI: 1417987967 LIC: DN6188 General Dentist servicing as: Pediatric Dentistry # DN18661 Whitford, Drew* # DN24628FL Bauman, Eric # 010980 NPI: 1932174448 LIC: DN12941 NPI: 1851527303 LIC: DN18661 NPI: 1114017209 LIC: DN24628FL CERTIFICATIONS: Affordable Dentures - # DN20886 Wells, Rachelle # DN7077 Benjamin, Paul • Inhalation Sedation Gainesville, P.A. NPI: 1588858286 LIC: DN20886 NPI: 1225057128 LIC: DN7077 9200 Nw 39Th Ave, Ste 200 CERTIFICATIONS: # 010934 # DTP675 Camargo, Carlos Gainesville, FL 32606 • Inhalation Sedation Edwin F. Johary, DDS NPI: 1518459312 LIC: DTP675 (352) 376-8229 1831 Nw 13Th Street, Ste #4 Special Needs: Yes # CHC014623 # DN8382 Cook, Larry Gainesville, FL 32609 English DOH - Alachua County NPI: 1902813777 LIC: DN8382 (352) 377-0360 M-T 7:45 am - 3pm Health Department Special Needs: Yes # DN20352FL Corasro, Andrew W-F 7:45 am - 3pm 816 Sw 64Th Terrance English, Spanish NPI: 1144656232 LIC: DN20352FL Gainesville, FL 32607 # DN6996 Showstark, Stephan W-F 9am - 5pm (352) 334-8839 # DTP630 Delgado Caraballo, NPI: 1639266562 LIC: DN6996 Special Needs: Yes # DN15990 Johary, Edwin* Maria # DN6188 Witt, William English, Russian, Bulgarian, NPI: 1609916899 LIC: DN15990 NPI: 1003274002 LIC: DTP630 NPI: 1417987967 LIC: DN6188 German, Italian, Spanish CERTIFICATIONS: # DTP603 Delgado, Alejandro

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 1 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1669887485 LIC: DTP603 NPI: 1437535218 LIC: DTP612 # DTP664 Freburg-Hoffmeister, # DTP439 O'Neill, Edgar # DTP639 Dias Ribeiro, Ana # DTP683 Reis, Andre Danielle NPI: 1235195413 LIC: DTP439 NPI: 1447545132 LIC: DTP664 NPI: 1053860924 LIC: DTP639 NPI: 1891278768 LIC: DTP683 BAY COUNTY CERTIFICATIONS: # DN13471 Dilbone, Deborah # DN14930 Rey, Rosalia • Inhalation Sedation NPI: 1104882497 LIC: DN13471 NPI: 1346341443 LIC: DN14930 DENTIST # DTP709 Gohel, Anita # DN16318 Djuric, Amira # DTP490 Ribeiro-DaSilva, NPI: 1841563947 LIC: DTP709 # FQHC022012 NPI: 1033291471 LIC: DN16318 Margarete # DN19786 Hamrick, Clayton PanCare of Florida NPI: 1326228321 LIC: DTP490 # DN8807FL Garvey, Timothy NPI: 1548523665 LIC: DN19786 12427 Hwy 231 NPI: 1205892296 LIC: DN8807FL # DTP703 Rocha, Mateus # DN12910 Hardeman, John Youngstown, FL 32466 NPI: 1376193060 LIC: DTP703 # DTP400 Gibbs, Micaela NPI: 1447343918 LIC: DN12910 (850) 753-3246 # DTP562 Roulet, Jean-Francois Special Needs: Yes NPI: 1902862469 LIC: DTP400 CERTIFICATIONS: NPI: 1831539816 LIC: DTP562 English # DTP710 Gohel, Rajendra • Inhalation Sedation • General Anesthesia M-T 8am - 5pm NPI: 1912071754 LIC: DTP710 # DTP669 Sikand, Rebecca • Board Certification W-F 8am - 5pm NPI: 1942654546 LIC: DTP669 # DTP680 Guha, Upoma # DTP718 Vyas, Rutvi # DN10365FL Barry, Steven NPI: 1184153132 LIC: DTP680 # DTP645 Silva, Maria NPI: 1710463013 LIC: DTP718 NPI: 1497826531 LIC: DN10365FL NPI: 1932452547 LIC: DTP645 # DN7710 Haddix, James # DN19128 Claussen, Meghann NPI: 1336105709 LIC: DN7710 # DTP652 Soto, Annetty PERIODONTICS NPI: 1336454651 LIC: DN19128 NPI: 1780024315 LIC: DTP652 # DTP672 Haddock, Fernando # DTP606 Chang, Jia # DN25097 Haynam, Eric NPI: 1477531234 LIC: DTP672 # DN22024 Terza, Stephanni NPI: 1871862029 LIC: DTP606 NPI: 1043688831 LIC: DN25097 NPI: 1588014591 LIC: DN22024 # DN9870 Kaleel, Nicholas # DTP687 Duarte Reis, Poliana # DN13094 Hudon, Richard NPI: 1447258991 LIC: DN9870 NPI: 1619448677 LIC: DTP687 ENDODONTICS NPI: 1245336031 LIC: DN13094 # DN21295 Luaces, Olga # DTP638 Duarte, Wagner # DTP654 Bakiri, Eleonora # DN21740 Moffa, Michelle NPI: 1407237555 LIC: DN21295 NPI: 1407305022 LIC: DTP638 NPI: 1952834418 LIC: DTP654 General Dentist servicing as: # DTP659 Migliorati, Cesar # DN21876 Schey, Karin # DN14544 Cerrud, Clinio NPI: 1841277407 LIC: DN21740 NPI: 1992810519 LIC: DTP659 NPI: 1285086173 LIC: DN21876 NPI: 1629184676 LIC: DN14544 # DN19745 Norton, Andrew CERTIFICATIONS: # DTP690 Tanaka, Tsuyoshi CERTIFICATIONS: NPI: 1861754020 LIC: DN19745 • Inhalation Sedation • Inhalation Sedation NPI: 1407208853 LIC: DTP690 # DTP497 Nascimento, Marcelle # DN18871 Pate, Sheena # DTP450 Pileggi, Roberta NPI: 1275706426 LIC: DTP497 PROSTHODONTICS General Dentist servicing as: NPI: 1356393821 LIC: DTP450 Pediatric Dentistry # DTP702 Oliveira, Dayane CERTIFICATIONS: # DTP722FL Cabrera da Silva, NPI: 1215255880 LIC: DN18871 NPI: 1487204178 LIC: DTP702 • Inhalation Sedation Alexandre # DN21660 Piorkowski, Gary • Board Certification NPI: 1962004408 LIC: DTP722FL # DN16197 Orlando, Joseph General Dentist servicing as: NPI 1326176389 LIC: DN16197 # DTP390 Echeto, Luisa : ORAL SURGEON NPI: 1699705434 LIC: DN21660 # DN8944 Ottenga, Marc NPI: 1144286386 LIC: DTP390 # DTP232 Dolwick, Melvin # DN23084 Santos, Iris NPI: 1306802293 LIC: DN8944 # DTP467 Esquivel-Upshaw, NPI: 1659337590 LIC: DTP232 NPI: 1487875233 LIC: DN23084 CERTIFICATIONS: Josephine CERTIFICATIONS: # HAD69 Smith, Amy • Inhalation Sedation NPI 1760495527 LIC: DTP467 • Inhalation Sedation : NPI: 1831209899 LIC: HAD69 # DTP612 Pereira, Patricia • Board Certification

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 2 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN18668 Van Dyke, NPI: 1487875233 LIC: DN23084 # DN24877FL Funaro, Sarah NPI: 1811922966 LIC: DN13760 Kanyaratana # HAD69 Smith, Amy NPI: 1437772118 LIC: DN24877FL # DN20658 Smith, Ross* NPI: 1003122656 LIC: DN18668 NPI: 1831209899 LIC: HAD69 # DN13760 Hachmeister, Kevin General Dentist servicing as: Pediatric Dentistry # HAD65 Wilhite, Rhonda # DN18668 Van Dyke, NPI: 1811922966 LIC: DN13760 NPI: 1245626811 LIC: DN20658 General Dentist servicing as: Kanyaratana # DN20658 Smith, Ross CERTIFICATIONS: NPI: 1952496341 LIC: HAD65 NPI: 1003122656 LIC: DN18668 General Dentist servicing as: • Inhalation Sedation Pediatric Dentistry # DN22573 Williams, Sean # HAD65 Wilhite, Rhonda # DN24606FL Youssef, Rabie* NPI 1245626811 LIC: DN20658 General Dentist servicing as: : NPI: 1306376512 LIC: DN22573 NPI: 1285284695 LIC: DN24606FL CERTIFICATIONS: NPI: 1952496341 LIC: HAD65 • Inhalation Sedation # FQHC010683 # FQHC016241 # DN22573 Williams, Sean # DN24606FL Youssef, Rabie PanCare of Florida, Inc. Brevard Health Alliance NPI: 1306376512 LIC: DN22573 NPI: 1285284695 LIC: DN24606FL 403 E. 11Th St 7227 N. Us Hwy 1 Panama City, FL 32401 BREVARD COUNTY # FQHC011682 Cocoa, FL 32927 (850) 767-3350 (321) 877-2740 DENTIST Brevard Health Alliance Special Needs: Yes Special Needs: Yes 220 Barton Blvd, Unit C14 English, Spanish English, Spanish # FQHC011681 Rockledge, FL 32955 M-T 8am - 5pm M-T 8am - 6pm (321) 639-5177 W-F 8am - 5pm Brevard Health Alliance W-Th 8am - 6pm Special Needs: Yes # DN10365FL Barry, Steven 2120 Sarno Rd English, Spanish # DN24790FL Adeniyi, Adetola NPI: 1497826531 LIC: DN10365FL Melbourne, FL 32935 M-T 8am - 6pm NPI: 1598217069 LIC: DN24790FL (321) 241-6800 # DN19128 Claussen, Meghann W-Th 8am - 6pm Special Needs: Yes # HAD82 Alongi, Jennifer NPI: 1336454651 LIC: DN19128 English, Spanish # DN24790FL Adeniyi, Adetola* General Dentist servicing as: Pediatric Dentistry # DN25097 Haynam, Eric M-T 8am - 5pm NPI: 1598217069 LIC: DN24790FL NPI: 1306139019 LIC: HAD82 NPI: 1043688831 LIC: DN25097 W-F 8am - 5pm # HAD82 Alongi, Jennifer* CERTIFICATIONS: # DN13094 Hudon, Richard # DN24790FL Adeniyi, Adetola General Dentist servicing as: • Inhalation Sedation NPI: 1245336031 LIC: DN13094 NPI: 1598217069 LIC: DN24790FL Pediatric Dentistry # DN22332FL Baddour, Mary NPI: 1306139019 LIC: HAD82 # DN21740 Moffa, Michelle # HAD82 Alongi, Jennifer NPI: 1730630633 LIC: DN22332FL CERTIFICATIONS: General Dentist servicing as: General Dentist servicing as: • Inhalation Sedation # DN14021 Cheshire, Gregory NPI: 1841277407 LIC: DN21740 Pediatric Dentistry # DN22332FL Baddour, Mary* General Dentist servicing as: NPI: 1306139019 LIC: HAD82 # DN19745 Norton, Andrew Pediatric Dentistry CERTIFICATIONS: NPI: 1730630633 LIC: DN22332FL NPI: 1861754020 LIC: DN19745 NPI: 1952303059 LIC: DN14021 • Inhalation Sedation # DN14021 Cheshire, Gregory* CERTIFICATIONS: # DN18871 Pate, Sheena # DN22332FL Baddour, Mary General Dentist servicing as: • Inhalation Sedation General Dentist servicing as: NPI: 1730630633 LIC: DN22332FL Pediatric Dentistry # DN21925 Eley, Joel Pediatric Dentistry NPI: 1952303059 LIC: DN14021 # DN14021 Cheshire, Gregory General Dentist servicing as: NPI: 1215255880 LIC: DN18871 CERTIFICATIONS: General Dentist servicing as: Pediatric Dentistry # DN21660 Piorkowski, Gary • Inhalation Sedation Pediatric Dentistry NPI: 1326491093 LIC: DN21925 General Dentist servicing as: # DN24877FL Funaro, Sarah* NPI: 1952303059 LIC: DN14021 CERTIFICATIONS: NPI: 1699705434 LIC: DN21660 CERTIFICATIONS: NPI: 1437772118 LIC: DN24877FL • Inhalation Sedation

# DN23084 Santos, Iris • Inhalation Sedation # DN13760 Hachmeister, Kevin* # DN9369 Estes, Philip

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 3 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

General Dentist servicing as: (321) 637-7300 CERTIFICATIONS: # DN16620 Yeoshoua, Oded Pediatric Dentistry Special Needs: Yes • Board Certification NPI: 1396969507 LIC: DN16620 NPI: 1255766937 LIC: DN9369 English, Spanish BROWARD COUNTY CERTIFICATIONS: M-T 8am - 5pm # 022277 • Inhalation Sedation W-F 8am - 5pm DENTIST Allure Dental of Plantation # DN24877FL Funaro, Sarah # DN11663 Bridges, Catherine PLLC NPI: 1437772118 LIC: DN24877FL NPI: 1659309821 LIC: DN11663 # 008934 1945 N Pine Island Road

# DN13760 Hachmeister, Kevin # DN17682 Klair, Kelly Ahmad Ahmadi D.M.D., PA Fort Lauderdale, FL 33322 (954) 473-9161 NPI: 1811922966 LIC: DN13760 NPI: 1205033222 LIC: DN17682 12311 Taft Street Ste 2 Special Needs: Yes Pembroke Pines, FL 33026 # DN20658 Smith, Ross # DN11385 Traul Jr., Robert English, Russian, Spanish General Dentist servicing as: www.pearlywhitesmiles.fl.com General Dentist servicing as: M-T 9am - 5pm Pediatric Dentistry Pediatric Dentistry (954) 430-5700 Special Needs: Yes W-F 9am - 5pm NPI: 1245626811 LIC: DN20658 NPI: 1982734257 LIC: DN11385 CERTIFICATIONS: English, Spanish, Persian # DN24891 Calderon, Kelly • Inhalation Sedation PEDIATRIC DENTISTRY # DN16261 Ahmadi, Ahmad NPI: 1306463344 LIC: DN24891 # DN24606FL Youssef, Rabie NPI: 1538275292 LIC: DN16261 # DN20596 Coyle, Sean # CHC015259 NPI: 1285284695 LIC: DN24606FL NPI: 1962814632 LIC: DN20596 DOH - Brevard County # 008935 # DN20696 Kopynets, Viktor # CHC015259 Health Department Ahmad Ahmadi D.M.D., PA General Dentist servicing as: DOH - Brevard County 2555 Judge Fran Jamieson Way 6656 Parkside Drive Pediatric Dentistry Viera, FL 32940 Health Department Parkland, FL 33067 NPI: 1932517042 LIC: DN20696 2555 Judge Fran Jamieson Way (321) 639-5801 www.pearlywhitesmiles.fl.com CERTIFICATIONS: Viera, FL 32940 Special Needs: Yes (954) 752-8283 • Inhalation Sedation (321) 639-5801 English, Spanish Special Needs: Yes # DN12167 Kunstmann, Vivian Special Needs: Yes M-T 8am - 5pm English, Spanish, Persian General Dentist servicing as: English, Spanish W-F 8am - 5pm # DN16261 Ahmadi, Ahmad Pediatric Dentistry M-T 8am - 5pm # HAD31 Cunnion, Dara NPI: 1538275292 LIC: DN16261 NPI: 1104995539 LIC: DN12167 W-F 8am - 5pm NPI: 1427128727 LIC: HAD31 # DN23637 Lopez, Catherine # DN11663 Bridges, Catherine CERTIFICATIONS: # 013157 NPI: 1558841890 LIC: DN23637 NPI: 1659309821 LIC: DN11663 • Board Certification All Care Dental # DN24073 Martinez, Lester # DN17682 Klair, Kelly 3207 North State Road 7, Ste # CHC015260 NPI: 1689235624 LIC: DN24073 24 NPI: 1205033222 LIC: DN17682 DOH - Brevard County Margate, FL 33063 # DN17761 Valdman, Vadim # DN11385 Traul Jr., Robert Health Department (954) 979-1357 NPI: 1184860413 LIC: DN17761 General Dentist servicing as: 611 N. Singleton Ave Special Needs: Yes CERTIFICATIONS: Pediatric Dentistry Titusville, FL 32796 English, Spanish, Portuguese • Inhalation Sedation NPI: 1982734257 LIC: DN11385 (321) 637-7300 M-T 9:30 am - 5pm Special Needs: Yes # 016880 # CHC015260 # DN22957FL Ortiz Javier, English, Spanish Allure Dental PLLC DOH - Brevard County M-T 8am - 5pm Alexandra 4267 W. Commerical Blvd Health Department W-F 8am - 5pm NPI: 1104340322 LIC: DN22957FL Tamarac, FL 33319 611 N. Singleton Ave # DN19530 Swanson, Wendy # HAD31 Cunnion, Dara (954) 677-3202 Titusville, FL 32796 NPI: 1427128727 LIC: HAD31 NPI: 1790085819 LIC: DN19530 Special Needs: Yes

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 4 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

English, Russian, French, Spanish W-F 8am - 5pm Broward Family Dental Care NPI: 1538713979 LIC: DN24375FL M-T 9am - 5pm # DN22185 Gonzalez, Darlen* 6260 W. Oakland Park Blvd # DN20710 Gonzalez, Kely Th-F 9am - 5pm NPI: 1649623034 LIC: DN22185 Sunrise, FL 33313 NPI: 1952717027 LIC: DN20710 # DN24891 Calderon, Kelly (954) 742-7995 # DN19939 Ruiz Frontany, # DN20151 Gonzalez, Kenia NPI: 1306463344 LIC: DN24891 Special Needs: Yes Yarimar* General Dentist servicing as: English, Farsi, Spanish # DN20596 Coyle, Sean NPI: 1134429251 LIC: DN19939 Pediatric Dentistry NPI: 1962814632 LIC: DN20596 CERTIFICATIONS: # DN14848 Fadavi, Sayed* NPI: 1578902813 LIC: DN20151 • Inhalation Sedation NPI: 1245247097 LIC: DN14848 # DN20696 Kopynets, Viktor # DN17335FL Guilarte, Rhona General Dentist servicing as: NPI: 1619956323 LIC: DN17335FL # 020606 # 006578 Pediatric Dentistry Bright Smiles of Sunrise Broward Mall Dental # DN23847 Khan, Adiba NPI: 1932517042 LIC: DN20696 NPI: 1649638172 LIC: DN23847 CERTIFICATIONS: 10108 W Oakland Park Blvd. 8000 W. Broward Blvd, Ste 1123 • Inhalation Sedation Sunrise, FL 33351 Plantation, FL 33388 # DN22197 Khatib, Adel (954) 900-2059 # DN23637 Lopez, Catherine (954) 476-0802 General Dentist servicing as: Special Needs: No Special Needs: Yes Endodontics NPI: 1558841890 LIC: DN23637 English, Spanish English, Russian, Spanish NPI: 1235582503 LIC: DN22197 # DN17761 Valdman, Vadim M 10am - 7pm, T 9am - 5pm M-T 11am - 4pm # DN16377 Krasnov, Rostislav NPI: 1184860413 LIC: DN17761 W 9am - 6pm, Th 9am - 5pm, F W-F 11am - 4pm NPI: 1942267935 LIC: DN16377 CERTIFICATIONS: 9am - 1pm # DN25272 Alameri, Mustafa # DN24131 Krupnov, Vera • Inhalation Sedation # DN21846 Fonseca, Jacqueline NPI: 1912516626 LIC: DN25272 NPI: 1487005369 LIC: DN21846 NPI: 1386202984 LIC: DN24131 # 008282 # DN22246 Antezana, Mauricio # DN20101 Licina, Zeljka Andrew Dental Care Center, General Dentist servicing as: # FQHC020446 NPI: 1013263292 LIC: DN20101 PA Broward Community & Pediatric Dentistry 3909 N. Andrews Ave NPI: 1063876399 LIC: DN22246 # DN24055 Lodhi, Hafsa Family Health Centers, Inc Oakland Park, FL 33309 NPI: 1588023584 LIC: DN24055 162 N. Powerline Rd. # DN17412 Atkinson, William andrewsdentalcarecenter.net Pompano Beach, FL 33069 General Dentist servicing as: # DN23637 Lopez, Catherine (954) 561-6675 www.bcfhc.org Pediatric Dentistry NPI: 1558841890 LIC: DN23637 Special Needs: Yes NPI: 1942360862 LIC: DN17412 (954) 970-7067 # DN19470 Maniglia, Marielba English, Spanish, Haitian; Haitian Special Needs: Yes CERTIFICATIONS: Creole NPI: 1063793644 LIC: DN19470 English, Spanish, Creoles and • Inhalation Sedation W-F 9am - 5pm Pidgins (other), French # DN21812 Cabrera, Rene # 24529 Moini, Marshall # DN17611 Riley, Marilyn* M 8:30 am - 5pm, T 10am - 7pm General Dentist servicing as: NPI: 1437700937 LIC: 24529 NPI: 1114941614 LIC: DN17611 W-F 8:30 am - 5pm Pediatric Dentistry # DN23402 Montenegro, Christian NPI: 1518313675 LIC: DN21812 # DN23003 Aldorri, Khalid NPI: 1144714445 LIC: DN23402 # 010213 NPI: 1396261277 LIC: DN23003 # DN24313FL Evans, Mana Bella Family Dental, Inc. # DN22018 Pansuriya, # DN24341 Salas, Julio NPI: 1750818712 LIC: DN24313FL Dharmendra 19551 Sheridan Street NPI 1427619253 LIC: DN24341 # DN22714 Fornes-Ferrero, General Dentist servicing as: Pembroke Pines, FL 33332 : Patricia Pediatric Dentistry www.mybellafamilydental,com # DN22291 Taylor, Shelly General Dentist servicing as: NPI: 1932645736 LIC: DN22018 (954) 621-7959 NPI: 1508224155 LIC: DN22291 Pediatric Dentistry Special Needs: Yes # DN22702 Pham, Quynhnhu NPI: 1619407566 LIC: DN22714 English, Spanish # 012454 NPI: 1609323948 LIC: DN22702 M-T 8am - 5pm # DN24375FL Gaton Molina, Sarah

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 5 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23007 Rivera, Lina # DN18594 Eugene, David NPI: 1447819396 LIC: DN24104 NPI: 1801230768 LIC: DN21495

NPI: 1760908743 LIC: DN23007 NPI: 1306080304 LIC: DN18594 # DN23700 Gonzalez, Carmen # DN24393 Vimo, Belen # DN23257 Shippee, Rebecca NPI: 1285110718 LIC: DN23700 NPI: 1144879925 LIC: DN24393 # 019656 NPI: 1841778164 LIC: DN23257 # DN23529 Gonzalez, Giovanni # DN23764 Wilkins, Lorena Dental Excellence Partners # DN24155 Trivedi, Sujay NPI: 1417436189 LIC: DN23529 NPI: 1669950192 LIC: DN23764 680 N. University Drive NPI: 1356909352 LIC: DN24155 # DN19802 Hernandez, David Pembroke Pines, FL 33024 # 123709 # DN21066 Uzunova-Dimova, (954) 982-7645 NPI: 1245593896 LIC: DN19802 Dental Excellence Partners Kalina Special Needs: Yes # DN19522 Hernandez, Stephanie LLC General Dentist servicing as: English, Spanish NPI: 1669751871 LIC: DN19522 4020 W. Hillsboro Blvd. Pediatric Dentistry M-T 8am - 5pm # DN23644 Martinez Morales, Deerfield Beach, FL 33442 NPI: 1245540947 LIC: DN21066 W-F 8am - 5pm Lesner (754) 240-4304 # DN14815 Alcequiez, Zeneyda # FQHC014907 NPI: 1619453743 LIC: DN23644 Special Needs: Yes NPI: 1124241989 LIC: DN14815 English, Spanish Community AIDS Resource, # DN25261FL Montero, Yenisey # DN23321 Aleman, Jose M-T 8am - 5pm Inc. NPI: 1740786599 LIC: DN25261FL W-F 8am - 5pm 871 W. Oakland Park Blvd NPI: 1770061020 LIC: DN23321 # DN22889 Mostatabzadeh, Amir Fort Lauderdale, FL 33311 # DN20182 Aponte-Barrios, Secil # DN14815 Alcequiez, Zeneyda (954) 567-7141 NPI: 1457883019 LIC: DN22889 NPI: 1164714176 LIC: DN20182 NPI: 1124241989 LIC: DN14815 Special Needs: Yes # DN23899 Moya, Yudit # DN21645 Baez Henry, # DN23321 Aleman, Jose English, Spanish, Creoles and NPI: 1144793233 LIC: DN23899 NPI: 1770061020 LIC: DN23321 Pidgins French-based(other) Carlianette # DN24672 Pilarte, Graciela M-T 8am - 5:15 pm NPI: 1235594961 LIC: DN21645 # DN21645 Baez Henry, NPI: 1548691017 LIC: DN24672 Th-F 8am - 5:15 pm # DN22998 Boeras Garcia, Suibel Carlianette # DN22255 # DN13731 Barnes, Curtis NPI: 1063939890 LIC: DN22998 Rajschmir, Silvina NPI: 1235594961 LIC: DN21645 General Dentist servicing as: NPI: 1689798936 LIC: DN13731 # DN15630 Cano, Lourdes # DN15630 Cano, Lourdes Pediatric Dentistry NPI: 1093867947 LIC: DN15630 # DN18139 Casas, Manuel NPI: 1093867947 LIC: DN15630 NPI: 1679977896 LIC: DN22255 NPI: 1740420090 LIC: DN18139 # DN21572 Carballo, Mauro # DN21572 Carballo, Mauro # DN22999 Reyes, Christina NPI: 1508200635 LIC: DN21572 # DN20973 Martinez, Amy NPI: 1508200635 LIC: DN21572 NPI: 1679931000 LIC: DN22999 NPI: 1124382866 LIC: DN20973 # DN24362 Cortes Fontanet, # DN12668 Congote, Luis # DN11150 Reyes, Miguel Raisa # DN20674 Sardinas, Yoan General Dentist servicing as: NPI: 1407948482 LIC: DN11150 NPI: 1124505268 LIC: DN24362 NPI: 1992118657 LIC: DN20674 Pediatric Dentistry # DN24069 Rodriguez Gonzalez, NPI: 1679774426 LIC: DN12668 # DN23695 Cruz, Yanet David # 013315 # DN23695 Cruz, Yanet NPI: 1508225376 LIC: DN23695 NPI: 1548798960 LIC: DN24069 David Eugene, DDS, PLLC NPI: 1508225376 LIC: DN23695 # DN24481 Defaus Fernandez, # DN19389 Sanchez, Arnaldo 2447 North State Road 7 # DN24481 Defaus Fernandez, Beatriz NPI: 1831486844 LIC: DN19389 Fort Lauderdale, FL 33313 Beatriz NPI: 1023558087 LIC: DN24481 (954) 733-9971 # DN24107 Serhan Lopez, Nayef NPI: 1023558087 LIC: DN24481 # DN23705 Diaz Valle, Orlando Special Needs: Yes NPI: 1184282550 LIC: DN24107 # DN23705 Diaz Valle, Orlando NPI: 1457717290 LIC: DN23705 French, English, Creoles and # DN17332 Simon, Gelsys Pidgins French-based(other) NPI: 1457717290 LIC: DN23705 # DN24104 Gonzalez Junco, Luis NPI: 1629154299 LIC: DN17332 M-T 9am - 4pm # DN24104 Gonzalez Junco, Luis NPI: 1447819396 LIC: DN24104 W-Th 9am - 4pm # DN21495 Streett, Rosario

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 6 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23700 Gonzalez, Carmen (954) 776-3320 NPI: 1619453743 LIC: DN23644 English, Spanish Special Needs: Yes M-T 9am - 5pm NPI: 1285110718 LIC: DN23700 # DN25261FL Montero, Yenisey English, Spanish # DN23529 Gonzalez, Giovanni NPI: 1740786599 LIC: DN25261FL # DN21528 Quezada, Pedro W-F 8am - 4pm NPI: 1164898177 LIC: DN21528 NPI: 1417436189 LIC: DN23529 # DN22889 Mostatabzadeh, Amir # DN14815 Alcequiez, Zeneyda # DN19802 Hernandez, David NPI: 1457883019 LIC: DN22889 NPI: 1124241989 LIC: DN14815 # 007554 NPI: 1245593896 LIC: DN19802 # DN23899 Moya, Yudit # DN23321 Aleman, Jose Dr. Ira Goldman # DN19522 Hernandez, Stephanie NPI: 1144793233 LIC: DN23899 NPI: 1770061020 LIC: DN23321 2100 East Hallendale Beach Blvd, NPI: 1669751871 LIC: DN19522 # DN24672 Pilarte, Graciela Ste # 409 # DN21645 Baez Henry, # DN23644 Martinez Morales, NPI 1548691017 LIC: DN24672 Hallandale, FL 33009 Carlianette : (954) 456-9844 Lesner # DN22255 Rajschmir, Silvina NPI: 1235594961 LIC: DN21645 Special Needs: No NPI: 1619453743 LIC: DN23644 General Dentist servicing as: # DN22998 Boeras Garcia, Suibel English # DN25261FL Montero, Yenisey Pediatric Dentistry NPI: 1063939890 LIC: DN22998 M 9am - 1pm, T 9am - 5pm NPI: 1679977896 LIC: DN22255 NPI: 1740786599 LIC: DN25261FL W-Th 9am - 5pm # DN21572 Carballo, Mauro # DN23899 Moya, Yudit # DN22999 Reyes, Christina NPI: 1508200635 LIC: DN21572 # DN5717 Goldman, Ira* NPI: 1679931000 LIC: DN22999 NPI: 1144793233 LIC: DN23899 NPI: 1326113937 LIC: DN5717 # DN12668 Congote, Luis # DN24672 Pilarte, Graciela # DN11150 Reyes, Miguel General Dentist servicing as: NPI: 1407948482 LIC: DN11150 # 020227 NPI: 1548691017 LIC: DN24672 Pediatric Dentistry Family Dental Associates PA # DN22255 Rajschmir, Silvina NPI: 1679774426 LIC: DN12668 # DN24069 Rodriguez Gonzalez, David 6130 West Atlantic Blvd General Dentist servicing as: # DN23695 Cruz, Yanet Pediatric Dentistry NPI: 1548798960 LIC: DN24069 Margate, FL 33063 NPI: 1508225376 LIC: DN23695 www.familydental.biz NPI: 1679977896 LIC: DN22255 # DN19389 Sanchez, Arnaldo # DN24481 Defaus Fernandez, (954) 973-0990 # DN22999 Reyes, Christina NPI: 1831486844 LIC: DN19389 Beatriz Special Needs: Yes NPI: 1679931000 LIC: DN22999 NPI: 1023558087 LIC: DN24481 # DN24107 Serhan Lopez, Nayef English, Spanish, Creoles and DN11150 Pidgins (other) # Reyes, Miguel # DN23705 Diaz Valle, Orlando NPI: 1184282550 LIC: DN24107 M-T 8am - 5pm NPI: 1407948482 LIC: DN11150 NPI: 1457717290 LIC: DN23705 # DN17332 Simon, Gelsys W-F 8am - 5pm DN24107 # Serhan Lopez, Nayef # DN24104 Gonzalez Junco, Luis NPI: 1629154299 LIC: DN17332 # DN17643 Blackmore, Sofia NPI: 1184282550 LIC: DN24107 NPI: 1447819396 LIC: DN24104 # DN21495 Streett, Rosario NPI: 1427387687 LIC: DN17643 DN17332 # Simon, Gelsys # DN23700 Gonzalez, Carmen NPI: 1801230768 LIC: DN21495 # DN12687FL Fahey, Dana NPI: 1629154299 LIC: DN17332 NPI: 1285110718 LIC: DN23700 # DN24393 Vimo, Belen NPI: 1265617617 LIC: DN12687FL DN24393 # Vimo, Belen # DN23529 Gonzalez, Giovanni NPI: 1144879925 LIC: DN24393 # DN10097 Lewis, Brad NPI: 1144879925 LIC: DN24393 NPI: 1417436189 LIC: DN23529 # DN23764 Wilkins, Lorena NPI: 1376567685 LIC: DN10097 DN23764 # Wilkins, Lorena # DN19802 Hernandez, David NPI: 1669950192 LIC: DN23764 # DN19201 Mingel, Marc NPI: 1669950192 LIC: DN23764 NPI: 1245593896 LIC: DN19802 # EV866681 NPI: 1831402957 LIC: DN19201 # 020092 # DN19522 Hernandez, Stephanie Dr Quesada & Associates PA NPI: 1669751871 LIC: DN19522 # 010038 Dental Excellence Partners, 6267 W Sample Rd Family Dental Care LLC # DN23644 Martinez Morales, Pompano Beach, FL 33067 4358 N Federal Hwy Lesner (954) 341-4766 1600 N. State Rd 7, Ste 400 Fort Lauderdale, FL 33308 Special Needs: Yes Lauderhill, FL 33313

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 7 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

Member Services / Servicios para miembros : (833) 276-0850 www.familydentalcareusa.com NSU- BGMC Oral & • Conscious Sedation # 017850 (954) 581-9228 Maxillofacial Surgery # 019516 Special Needs: Yes Great Smiles Dental of Fort 1600 S. Andrews Ave, 3Rd Floor Perfect Smile Dental Spa English, Arabic, Spanish Lauderdale Fort Lauderdale, FL 33316 M-T 9am - 5pm 2633 E. Commercial Blvd Ste B (954) 355-5703 117 S. 21St Ave # DN18305 Akel, Bassil Fort Lauderdale, FL 33308 Special Needs: Yes Hollywood, FL 33020 (954) 530-5352 (954) 364-7626 NPI: 1700040557 LIC: DN18305 English, Spanish Special Needs: Yes W-F 9am - 5pm Special Needs: Yes English, Spanish English, Spanish # 013821 # DN13419 Ede-Nichols, Diane M-T 9am - 5pm M-T 9am - 5pm Gateway Dental Inc NPI: 1225145683 LIC: DN13419 W-F 9am - 5pm # DN15823 Galbut, Kimberly 6720 Pines Blvd. # DN21624FL Quimby, Anastasiya # DN19482 Pembroke Pines, FL 33024 Murcia, Marcela NPI: 1649580747 LIC: DN15823 NPI: 1750720116 LIC: DN21624FL (305) 856-2300 NPI: 1588952261 LIC: DN19482 # DN17884 Lyons, James Special Needs: Yes # 010341 NPI: 1851341853 LIC: DN17884 # 023228 Spanish, English NSU- JDCH Center for M-T 9am - 5pm JM Dental Group Inc # 017093 Cranio-Facial Pediatric & W-Th 9am - 5pm 1724 N. University Drive Preferred Dental Care, PA Dental Care # DN18302 Herrera, Victoria Pembroke Pines, FL 33024 3501 Johnson Street, Ste 200 2263 S. University Drive jmdentalgroup.com NPI: 1114185550 LIC: DN18302 Hollywood, FL 33021 Davie, FL 33324 (954) 432-8000 (954) 262-2187 (954) 475-0700 # DN15212 Miranda, Pablo Special Needs: Yes Special Needs: Yes Special Needs: Yes NPI: 1023036365 LIC: DN15212 English, Spanish English, Spanish English, Russian, Spanish # DN15477 Perrotti, Steven M-T 9am - 5pm M-T 8:30 am - 5pm M 9am - 6pm, T 10am - 7pm NPI: 1144249780 LIC: DN15477 W-F 9am - 5pm W-F 8:30 am - 5pm # DN24891 Calderon, Kelly # DN24330 Salazar, Melba # DN14451 Hernandez, Norberto # DN13419 Ede-Nichols, Diane NPI: 1306463344 LIC: DN24891 NPI: 1326690892 LIC: DN24330 NPI: 1285693267 LIC: DN14451 NPI: 1225145683 LIC: DN13419 # DN20596 Coyle, Sean # DN22991 Santiesteban, Aymara # 013365 NPI: 1962814632 LIC: DN20596 NPI: 1265826168 LIC: DN22991 # 017867 Lakes Mall Dental Center, PA # DN20696 Kopynets, Viktor Pembroke Miro Dental Office 11401 Pines Blvd, Ste 220 General Dentist servicing as: # 022831 7071 Taft Street Pembroke Pines, FL 33026 Pediatric Dentistry Gentle Teeth and Braces of Hollywood, FL 33024 (954) 432-5515 NPI: 1932517042 LIC: DN20696 Weston (954) 436-7699 Special Needs: No CERTIFICATIONS: 2751 Executive Park Drive Ste Special Needs: Yes English, Spanish • Inhalation Sedation 204 English, Spanish Th-F 10am - 5pm # DN23637 Lopez, Catherine Fort Lauderdale, FL 33331 M-T 9am - 5pm # DN23321 NPI: 1558841890 LIC: DN23637 (954) 217-0288 Aleman, Jose W-F 9am - 5pm Special Needs: Yes NPI: 1770061020 LIC: DN23321 # DN24073 Martinez, Lester # DN24641 De Oliveira Matias, English, Spanish # DN19377 Calderon, Erik Joao Victor NPI: 1689235624 LIC: DN24073 M-T 9am - 5pm NPI: 1942596416 LIC: DN19377 NPI: 1952854044 LIC: DN24641 # DN19416 Saldana, Ramon # DN22685 Perez-Borroto CERTIFICATIONS: # DN11650 Miro, Claudio NPI: 1639465735 LIC: DN19416 Rodrigez, Daylis • Inhalation Sedation NPI: 1417024118 LIC: DN11650 # DN17761 Valdman, Vadim NPI: 1790215309 LIC: DN22685 # 010345 CERTIFICATIONS: NPI: 1184860413 LIC: DN17761

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 8 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

CERTIFICATIONS: General Dentist servicing as: NPI: 1063793644 LIC: DN19470 # DN20938 Castello Polo, Blanca* • Inhalation Sedation Pediatric Dentistry # 24529 Moini, Marshall NPI: 1710380316 LIC: DN20938 NPI: 1942360862 LIC: DN17412 # EV791393 NPI: 1437700937 LIC: 24529 CERTIFICATIONS: # 015404 Royal Dental of Coral # DN23402 Montenegro, Christian • Inhalation Sedation Smile At Margate Springs # DN17123 Bravo, Raquel NPI: 1144714445 LIC: DN23402 5404 W. Atlantic Blvd 1401 N University Dr Ste 403 NPI: 1538312525 LIC: DN17123 # DN23454FL Nguyen, Michelle Pompano Beach, FL 33063 Pompano Beach, FL 33071 # DN21812 Cabrera, Rene General Dentist servicing as: smileatmargate.com (754) 229-6695 Endodontics (954) 974-4400 Special Needs: Yes General Dentist servicing as: Pediatric Dentistry NPI: 1033603733 LIC: DN23454FL Special Needs: Yes English, Spanish NPI: 1518313675 LIC: DN21812 CERTIFICATIONS: English, Farsi, Spanish M-T 9am - 5pm • Inhalation Sedation M 9am - 5:30 pm, T 11am - 7pm W-F 9am - 5pm # DN7894 Cullen, William # DN23652 Ospina, Luz W 9am - 5:30 pm, Th 11am - General Dentist servicing as: # DN25165FL Alrubaye, Hiba General Dentist servicing as: 7pm, F 9am - 3pm Pediatric Dentistry NPI: 1477059129 LIC: DN25165FL Oral Surgery NPI: 1013110535 LIC: DN7894 # DN19381 Shayan, Maria NPI: 1881181501 LIC: DN23652 # DN25050 Gross, Steven CERTIFICATIONS: NPI: 1700172673 LIC: DN19381 NPI: 1063029122 LIC: DN25050 • Inhalation Sedation # DN23021 Riboul, Sandrine # 010564 # DN16481 Zadov, Marianna # DN24313FL Evans, Mana NPI: 1609227057 LIC: DN23021 CERTIFICATIONS: Smile Solutions Dental NPI: 1104903301 LIC: DN16481 NPI: 1750818712 LIC: DN24313FL • Inhalation Sedation Group CERTIFICATIONS: # DN20710 Gonzalez, Kely # DN23007 Rivera, Lina 294 Nw 172Nd Ave • Inhalation Sedation NPI: 1952717027 LIC: DN20710 NPI: 1760908743 LIC: DN23007 Hollywood, FL 33029 # 006581 # DN17335FL Guilarte, Rhona (954) 432-3655 # DN20475 Santiago, Germaine Sawgrass Mills Mall Dental NPI: 1619956323 LIC: DN17335FL Special Needs: No NPI: 1922341460 LIC: DN20475 English, Spanish 12801 W. Sunrise Blvd, Ste F222 # DN23847 Khan, Adiba # DN23257 Shippee, Rebecca M-T 9am - 6pm Sunrise, FL 33323 NPI: 1649638172 LIC: DN23847 W-F 9am - 6pm (954) 846-7171 NPI: 1841778164 LIC: DN23257 # DN22197 Khatib, Adel Special Needs: Yes # DN21066 Uzunova-Dimova, # DN19465 De Sousa, Marvina General Dentist servicing as: Russian, Spanish, Creoles and Kalina NPI: 1841572963 LIC: DN19465 Endodontics Pidgins French-based(other) General Dentist servicing as: NPI: 1235582503 LIC: DN22197 # DN19470 Maniglia, Marielba M-T 10am - 9pm Pediatric Dentistry NPI: 1063793644 LIC: DN19470 W-F 10am - 9pm # DN16377 Krasnov, Rostislav NPI: 1245540947 LIC: DN21066 NPI: 1942267935 LIC: DN16377 # DN22246 Antezana, Mauricio # DN12510 Yatzkan, Maria # 014644 General Dentist servicing as: # DN24131 Krupnov, Vera NPI: 1770982183 LIC: DN12510 Smiles Dental PLLC Pediatric Dentistry NPI: 1386202984 LIC: DN24131 700 W. Hillsboro Blvd, Ste 1-109, NPI: 1063876399 LIC: DN22246 # 016127 # DN20101 Licina, Zeljka Bldg 1 # DN21079 Arnedo, Johanna NPI: 1013263292 LIC: DN20101 Shalom Sunset Dental Care Deerfield Beach, FL 33441 General Dentist servicing as: 6491 Sunset Strip, Ste 1 www.smilesdental.net # DN24055 Lodhi, Hafsa Pediatric Dentistry Sunrise, FL 33313 (754) 264-7264 NPI: 1588023584 LIC: DN24055 NPI: 1104213909 LIC: DN21079 www.shalomsunsetdental.com Special Needs: No CERTIFICATIONS: # DN23728 Lopez, Elssy (954) 572-1801 English, Spanish, Creoles and • Inhalation Sedation NPI: 1215439757 LIC: DN23728 Special Needs: No Pidgins English-based(other), # DN17412 Atkinson, William French, Hindi, Telugu # DN19470 Maniglia, Marielba 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 9 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

M-T 9am - 5pm Special Needs: Yes W-F 10am - 9pm English, Spanish

# DN15925 Atluri, Suneetha English, Spanish # DN13421 Gittess, Robert M-T 9am - 5pm M-T 8:30 am - 5pm W-F 9am - 5pm NPI: 1063525731 LIC: DN15925 NPI: 1922137058 LIC: DN13421 W-F 8:30 am - 5pm CERTIFICATIONS: # DTP600 Contasti-Bocco, • Inhalation Sedation # DN9429 Flax, Michael ORAL SURGEON Gisela* NPI: 1164583985 LIC: DN9429 NPI: 1871903914 LIC: DTP600 # 016630 # 010345 # DN18606 Manjarres, Vivian # DN16470 Vargas, Jorge* Soto & Castillo Dental Care NSU- BGMC Oral & NPI: 1073747333 LIC: DN18606 NPI: 1154419349 LIC: DN16470 Inc Maxillofacial Surgery # DN17496 Seltzer, Robert 3911 Hollywood Blvd, Ste 102 1600 S. Andrews Ave, 3Rd Floor # 022347 Hollywood, FL 33021 NPI: 1619082120 LIC: DN17496 Fort Lauderdale, FL 33316 Shaun L. Smith DDS PLLC sc-dentalcare.com # DN14230 Zeim, Jason (954) 355-5703 8223 W. Atlantic Blvd (954) 987-3344 Special Needs: Yes NPI: 1760498422 LIC: DN14230 Pompano Beach, FL 33071 Special Needs: Yes English, Spanish www.slsortho.com English, Spanish, Portuguese # 010346 W-F 9am - 5pm M-T 9am - 5pm (954) 368-0105 NSU- Pediatric Dental Care # ME99010 McClure, Shawn Special Needs: Yes W-F 9am - 5pm Center @ Kids NPI: 1649313925 LIC: ME99010 English, Spanish # DN20757 Castillo, Sandra 819 Ne 26Th St, Ste C CERTIFICATIONS: M 10am - 6pm, T 9am - 5pm NPI: 1245636133 LIC: DN20757 Wilton Manors, FL 33305 • Board Certification # DN23095 Smith, Shaun # DN20370 Soto, Paola (954) 567-5650 NPI: 1932499217 LIC: DN23095 Special Needs: Yes ORTHODONTIST NPI: 1336572007 LIC: DN20370 English, Spanish PEDIATRIC DENTISTRY ENDODONTICS M-T 9am - 5pm # 022905 W-F 9am - 5pm Lighthouse Point # 010345 # 006578 Orthodontics # DN9429 Flax, Michael* NSU- BGMC Oral & 2323 Ne 26Th Ave Ste 107 Broward Mall Dental NPI: 1164583985 LIC: DN9429 Pompano Beach, FL 33062 Maxillofacial Surgery 8000 W. Broward Blvd, Ste 1123 # DN18606 Manjarres, Vivian* www.lhporthodontics.com 1600 S. Andrews Ave, 3Rd Floor Plantation, FL 33388 Fort Lauderdale, FL 33316 NPI: 1073747333 LIC: DN18606 (954) 719-7955 (954) 476-0802 (954) 355-5703 # DN17496 Seltzer, Robert* Special Needs: Yes Special Needs: Yes Special Needs: Yes NPI: 1619082120 LIC: DN17496 English, Spanish English, Russian, Spanish English, Spanish M-T 8:30 am - 5pm M-T 11am - 4pm # DN14230 Zeim, Jason* W-F 9am - 5pm W-F 8:30 am - 5pm W-F 11am - 4pm NPI: 1760498422 LIC: DN14230 # DN20908 Mutawalli, Khalid # DN20160 Rozen, Daniel # DN13421 Gittess, Robert NPI: 1750754818 LIC: DN20908 # 006581 NPI: 1821446352 LIC: DN20160 NPI: 1922137058 LIC: DN13421 CERTIFICATIONS: Sawgrass Mills Mall Dental # 010346 • Pediatric Conscious Sedation # 010341 12801 W. Sunrise Blvd, Ste F222 • Inhalation Sedation NSU- Pediatric Dental Care NSU- JDCH Center for Sunrise, FL 33323 # DN17762 Ocanto, Romer Center @ Kids Cranio-Facial Pediatric & (954) 846-7171 819 Ne 26Th St, Ste C NPI: 1124133426 LIC: DN17762 Special Needs: Yes Dental Care Wilton Manors, FL 33305 CERTIFICATIONS: 3501 Johnson Street, Ste 200 Russian, Spanish, Creoles and (954) 567-5650 • Inhalation Sedation Pidgins French-based(other) Hollywood, FL 33021 # DN17441 Oramas, Victor M-T 10am - 9pm Special Needs: Yes (954) 262-2187

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 10 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1235217571 LIC: DN17441 • Inhalation Sedation # DTP643 Chin, Judith* NPI: 1124118245 LIC: DN13591 CERTIFICATIONS: # DN17441 Oramas, Victor NPI: 1124151592 LIC: DTP643 # 006581 • Board Certification NPI: 1235217571 LIC: DN17441 CERTIFICATIONS: CERTIFICATIONS: • Inhalation Sedation Sawgrass Mills Mall Dental # 010341 • Board Certification • Board Certification 12801 W. Sunrise Blvd, Ste F222 NSU- JDCH Center for # DTP557 Padilla, Oscar # DTP648 Kim, Margaret* Sunrise, FL 33323 Cranio-Facial Pediatric & NPI: 1669478863 LIC: DTP557 NPI: 1649292103 LIC: DTP648 (954) 846-7171 Dental Care Special Needs: Yes CERTIFICATIONS: CERTIFICATIONS: 3501 Johnson Street, Ste 200 • Inhalation Sedation • Inhalation Sedation Russian, Spanish, Creoles and Hollywood, FL 33021 # DTP259 Larumbe, Jose* Pidgins French-based(other) (954) 262-2187 # 010342 M-T 10am - 9pm NPI: 1972605038 LIC: DTP259 Special Needs: Yes W-F 10am - 9pm NSU- Mailman Segal CERTIFICATIONS: English, Spanish Institute - Dental • Inhalation Sedation # DN13591 Nielsen, Pamela M-T 8:30 am - 5pm 7600 Sw 36Th Street, Bldg.100, # DN20908 Mutawalli, Khalid* NPI: 1124118245 LIC: DN13591 W-F 8:30 am - 5pm Room 1263 NPI: 1750754818 LIC: DN20908 # DN4823 Arnold Jr., Dan Davie, FL 33328 CALHOUN COUNTY CERTIFICATIONS: NPI: 1275644668 LIC: DN4823 (954) 262-1817 • Pediatric Conscious Sedation Special Needs: Yes DENTIST CERTIFICATIONS: • Inhalation Sedation • Inhalation Sedation English, Spanish # DN17762 Ocanto, Romer* # 016515 # DTP695 Cabassa Latoni, M-T 8am - 5pm NPI: 1124133426 LIC: DN17762 Roberto W-F 8am - 5pm Layne & Barth Family CERTIFICATIONS: # DN17762 Ocanto, Romer Dentistry, P.A. NPI: 1063483444 LIC: DTP695 • Inhalation Sedation 19606 State Road 20 W # DTP643 Chin, Judith NPI: 1124133426 LIC: DN17762 # DN17441 Oramas, Victor* Blountstown, FL 32424 CERTIFICATIONS: NPI: 1124151592 LIC: DTP643 NPI: 1235217571 LIC: DN17441 www.laynefamilydentistry.com • Inhalation Sedation CERTIFICATIONS: CERTIFICATIONS: (850) 674-5502 • Inhalation Sedation # 010346 • Board Certification Special Needs: Yes • Board Certification NSU- Pediatric Dental Care # DTP557 Padilla, Oscar* English # DTP648 Kim, Margaret Center @ Kids NPI: 1669478863 LIC: DTP557 M-T 8am - 5pm NPI: 1649292103 LIC: DTP648 819 Ne 26Th St, Ste C CERTIFICATIONS: W-Th 8am - 5pm CERTIFICATIONS: Wilton Manors, FL 33305 • Inhalation Sedation # DN19827 Barth, Nicholas* • Inhalation Sedation (954) 567-5650 NPI: 1396090320 LIC: DN19827 # DTP259 Larumbe, Jose PERIODONTICS Special Needs: Yes CERTIFICATIONS: NPI: 1972605038 LIC: DTP259 English, Spanish • Inhalation Sedation # 006578 CERTIFICATIONS: M-T 9am - 5pm # DN18715 Layne, Brad* • Inhalation Sedation W-F 9am - 5pm Broward Mall Dental NPI: 1851528962 LIC: DN18715 8000 W. Broward Blvd, Ste 1123 # DN20908 Mutawalli, Khalid # DN4823 Arnold Jr., Dan* Plantation, FL 33388 NPI: 1750754818 LIC: DN20908 NPI: 1275644668 LIC: DN4823 # 013160 (954) 476-0802 CERTIFICATIONS: CERTIFICATIONS: Myron D. Schrock, DMD, PA • Pediatric Conscious Sedation Special Needs: Yes • Inhalation Sedation 17470 North Main Street • Inhalation Sedation English, Russian, Spanish # DTP695 Cabassa Latoni, Blountstown, FL 32424 # DN17762 Ocanto, Romer M-T 11am - 4pm Roberto* www.myronshrockdmd.com W-F 11am - 4pm NPI: 1124133426 LIC: DN17762 NPI: 1063483444 LIC: DTP695 (850) 237-1400 CERTIFICATIONS: # DN13591 Nielsen, Pamela

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 11 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Special Needs: Yes NPI: 1891135331 LIC: DN20142 CERTIFICATIONS: Wisdom Dental PA • Inhalation Sedation English 5064 Annunciation Circle, Ste CLAY COUNTY • General Anesthesia M-T 8am - 4:30 pm 101 # DN10533 Imray, Scott # DN13527 Schrock, Myron DENTIST Ave Maria, FL 34142 General Dentist servicing as: NPI: 1740362367 LIC: DN10533 (239) 919-6930 CERTIFICATIONS: Special Needs: Yes NPI: 1730245846 LIC: DN13527 # CHC9679 • Inhalation Sedation English, Spanish DOH - Clay County Health • General Anesthesia CITRUS COUNTY M-T 8am - 4pm Department- Mobile Dental COLLIER COUNTY W-F 8am - 4pm DENTIST Unit # DN21551 Akpaka, Wisdom 1305 Idlewild Ave DENTIST NPI: 1114338738 LIC: DN21551 # CHC011210M Green Cove Springs, FL 32043 DOH - Citrus County Health (904) 259-6291 # CHC015257 COLUMBIA COUNTY Special Needs: Yes Department (Mobile Unit) DOH - Collier County Health English DENTIST 3700 W. Sovereign Path Department # DN14307 Lecanto, FL 34461 Gupton, Frank* 3339 East Tamiami Trail, Ste 145 # FQHC012459 (352) 527-5737 NPI: 1962411876 LIC: DN14307 Naples, FL 34106 Special Needs: Yes CERTIFICATIONS: (239) 252-5314 Palms Dentistry English • Inhalation Sedation Special Needs: Yes 173 Nw Albritton Lane M-T 8am - 4pm English, Spanish, Italian, Lake City, FL 32055 # EV922651 W-F 8am - 4pm Romanian (386) 752-5904 Green Cove Dental # DN11663 Bridges, Catherine* M-T 7:30 am - 4:30 pm Special Needs: Yes 200 S Orange Ave Ste B W 7:30 am - 5:30 pm, Th 7:30 NPI: 1659309821 LIC: DN11663 English Green Cove Springs, FL 32043 am - 4:30 pm, F 7:30 am - 12:30 M-T 8am - 5pm # DN11385 Traul Jr., Robert* pm (904) 297-8416 W-F 8am - 5pm General Dentist servicing as: Special Needs: Yes # DN19780 Danu, Dana Pediatric Dentistry # DN9869 Jones, Stanley English NPI: 1174887327 LIC: DN19780 NPI: 1982734257 LIC: DN11385 General Dentist servicing as: M-T 10am - 4pm # DN15182 Johnson, Kelley Pediatric Dentistry W-F 10am - 4pm # FQHC016660 NPI: 1699853887 LIC: DN15182 NPI: 1528162047 LIC: DN9869 # DN20382 Chery, Naderge Langley Health Services # DN22911 Koubek, Catherine NPI: 1457786337 LIC: DN20382 # 014619 314 S. Line Ave General Dentist servicing as: Northern Dental General Pediatric Dentistry Inverness, FL 34452 ORAL SURGEON (352) 419-4056 and Cosmetic Dentistry LLC NPI: 1730619594 LIC: DN22911 Special Needs: Yes 5651 Naples Blvd CERTIFICATIONS: # 018291 English Naples, FL 34109 • Inhalation Sedation Imray & Gesek DMD PA M-T 8am - 5pm (239) 431-5666 # DN24208 Lima, Pamela W-F 8am - 5pm 1409 Kingsley Ave Ste 5 Special Needs: Yes General Dentist servicing as: Orange Park, FL 32073 English, Spanish # DN24579FL Johnson, Christina Pediatric Dentistry (904) 264-7383 M-T 9am - 5pm NPI: 1982264438 LIC: DN24208 NPI: 1578104063 LIC: DN24579FL Special Needs: Yes # DN20711 Novak, Shannon # DN20927 Rooney, Matthew # DN23356 Lutes, Meaghan English NPI: 1871904581 LIC: DN20711 General Dentist servicing as: NPI: 1760974554 LIC: DN23356 # DN13575 Gesek, Daniel Pediatric Dentistry # DN20142 Matthews, Irina NPI: 1831129774 LIC: DN13575 # 022815 NPI: 1598165532 LIC: DN20927

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 12 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

CERTIFICATIONS: M-T 9am - 5pm (904) 296-7757 Special Needs: Yes • Inhalation Sedation W-Th 9am - 5pm Special Needs: Yes English, Arabic, Russian, Spanish English, Spanish, Hindi M-T 10am - 5pm DIXIE COUNTY # DN14991 Alniti, Daniel General Dentist servicing as: M-T 8:30 am - 4pm # DN22246 Antezana, Mauricio DENTIST Pediatric Dentistry # DN6329 Davis, Robert General Dentist servicing as: NPI: 1699978809 LIC: DN14991 NPI: 1962613901 LIC: DN6329 Pediatric Dentistry # 011247 # DN7301 McCabe, John NPI: 1063876399 LIC: DN22246 # FQHC020799 Family Cosmetic Dentistry General Dentist servicing as: # DN21079 Arnedo, Johanna I.M. Sulzbacher Center for 91 Se Highway 349 Pediatric Dentistry General Dentist servicing as: Old Town, FL 32680 NPI: 1588734149 LIC: DN7301 the Homeless, Inc. Pediatric Dentistry (352) 542-7400 611 E. Adams Street NPI: 1104213909 LIC: DN21079 # FQHC020800 Special Needs: No Jacksonville, FL 32202 CERTIFICATIONS: English Beaches Community Health (904) 394-8060 • Inhalation Sedation Dental Clinic Special Needs: Yes # DN17412 Atkinson, William # DN9531 Attia, Safwat* 850 6Th Ave South Ste #500 English, Spanish General Dentist servicing as: NPI: 1952311730 LIC: DN9531 Jacksonville Beach, FL 32250 M-T 8am - 4pm Pediatric Dentistry DUVAL COUNTY (904) 394-5471 W-Th 8am - 4pm NPI: 1942360862 LIC: DN17412 Special Needs: Yes # DN20613 Martin, Shakela* CERTIFICATIONS: English, Spanish DENTIST NPI: 1639582943 LIC: DN20613 • Inhalation Sedation # DN20613 Martin, Shakela* # DN17123 Bravo, Raquel # HAD108 Shakya, Jasmine* # 008933 NPI: 1639582943 LIC: DN20613 NPI: 1538312525 LIC: DN17123 NPI: 1528435971 LIC: HAD108 A Better Smile Denture # DN24546 Burns, Devin # 018601 Center # FQHC628699 NPI: 1699221556 LIC: DN24546 2804 St John'S Bluff Rd Ste 200 CAN Community Health, Inc. Pediatric Health Center at # DN21812 Cabrera, Rene Jacksonville, FL 32246 4615 Philips Hwy Ste 3 Sulzbacher Village General Dentist servicing as: (904) 493-1005 Jacksonville, FL 32207 5455 Springfield Blvd Pediatric Dentistry Special Needs: Yes (904) 508-0710 Jacksonville, FL 32208 NPI: 1518313675 LIC: DN21812 English, Spanish, Gujarati, Hindi Special Needs: Yes (904) 394-4963 # DN7894 Cullen, William M-T 9am - 4pm English, Spanish Special Needs: Yes General Dentist servicing as: # DN15848 Mumford-Clarke, M-T 8:30 am - 5:30 pm English Pediatric Dentistry Kymberli W-Th 8:30 am - 5:30 pm M-T 8am - 5pm NPI: 1013110535 LIC: DN7894 NPI: 1316965742 LIC: DN15848 # DN14864 Henry, Stephen* # DN20613 Martin, Shakela CERTIFICATIONS: CERTIFICATIONS: NPI: 1851455117 LIC: DN14864 NPI: 1639582943 LIC: DN20613 • Inhalation Sedation • Inhalation Sedation # DN20641 Makary, Sara* # HAD108 Shakya, Jasmine # DN24313FL Evans, Mana # EV1038774 NPI: 1851704654 LIC: DN20641 NPI: 1528435971 LIC: HAD108 NPI: 1750818712 LIC: DN24313FL AA Prime Care Dental # DN20945 Fornos, Jorge # 021571 # 009752 Associates NPI: 1831594415 LIC: DN20945 12276 San Jose Blvd Ste 101 Dentures & More - Coastal Regency Square Mall Dental # DN20710 Gonzalez, Kely Jacksonville, FL 32223 Dental Services P.A. (904) 862-2323 4402 Old Sailsbury Road 9501 Arlington Express Way Ste NPI: 1952717027 LIC: DN20710 Special Needs: Yes Jacksonville, FL 32216 0345 # DN17335FL Guilarte, Rhona www.fldental.com; English, French, Haitian; Haitian Jacksonville, FL 32225 NPI: 1619956323 LIC: DN17335FL Creole, Romanian www.aapledental.com (904) 727-6055

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 13 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23847 Khan, Adiba General Dentist servicing as: Jacksonville, FL 32209 M-T 7:30 am - 4pm Pediatric Dentistry (904) 244-2000 NPI: 1649638172 LIC: DN23847 # DN15601FL Wall, Tanya NPI: 1245540947 LIC: DN21066 Special Needs: Yes # DN22197 Khatib, Adel NPI: 1063528586 LIC: DN15601FL English, Arabic, Farsi, Portuguese, General Dentist servicing as: ORAL SURGEON Spanish PERIODONTICS Endodontics M-T 8am - 4:30 pm NPI: 1235582503 LIC: DN22197 # 018290 W-F 8am - 4:30 pm # 009752 # DN16377 Krasnov, Rostislav Imray & Gesek DMD PA # DTP665FL Bunnell, Anthony Regency Square Mall Dental NPI: 1942267935 LIC: DN16377 2047 Park St NPI: 1659690576 LIC: DTP665FL P.A. Jacksonville, FL 32204 # DN24131 Krupnov, Vera # DTP368 Fattahi, Tirbod 9501 Arlington Express Way Ste (904) 388-7665 0345 NPI: 1386202984 LIC: DN24131 NPI: 1093780603 LIC: DTP368 Special Needs: Yes Jacksonville, FL 32225 # DN20101 Licina, Zeljka # DTP453 Fernandes, Rui English (904) 727-6055 NPI: 1013263292 LIC: DN20101 M-T 8am - 5pm NPI: 1861467078 LIC: DTP453 Special Needs: Yes # DN24055 Lodhi, Hafsa W-Th 8am - 5pm # DTP618FL Salman, Salam English, Arabic, Russian, Spanish NPI: 1588023584 LIC: DN24055 # DN13575 Gesek, Daniel NPI: 1154555035 LIC: DTP618FL M-T 10am - 5pm NPI: 1831129774 LIC: DN13575 # DN23637 Lopez, Catherine # DTP362FL Schare, Howard # DN13591 Nielsen, Pamela CERTIFICATIONS: NPI: 1558841890 LIC: DN23637 NPI: 1114992633 LIC: DTP362FL NPI: 1124118245 LIC: DN13591 • Inhalation Sedation # DN19470 Maniglia, Marielba • General Anesthesia # DTP333 Steinberg, Barry ESCAMBIA COUNTY NPI LIC: : 1063793644 DN19470 # DN10533 Imray, Scott NPI: 1700851961 LIC: DTP333 # 24529 Moini, Marshall NPI: 1740362367 LIC: DN10533 DENTIST PEDIATRIC DENTISTRY NPI: 1437700937 LIC: 24529 CERTIFICATIONS: • Inhalation Sedation # EV789577 # DN23402 Montenegro, Christian • General Anesthesia # FQHC628699 CAN Community Health, Inc NPI: 1144714445 LIC: DN23402 Pediatric Health Center at 8390 N Palafox St # DN23652 Ospina, Luz # 009752 Sulzbacher Village Pensacola, FL 32534 General Dentist servicing as: Regency Square Mall Dental 5455 Springfield Blvd (850) 988-5245 Oral Surgery P.A. Jacksonville, FL 32208 Special Needs: Yes NPI: 1881181501 LIC: DN23652 9501 Arlington Express Way Ste (904) 394-4963 English, Spanish 0345 # DN23021 Riboul, Sandrine Special Needs: Yes M-T 8:30 am - 5:30 pm Jacksonville, FL 32225 NPI: 1609227057 LIC: DN23021 English W-Th 8:30 am - 5:30 pm (904) 727-6055 CERTIFICATIONS: M-T 8am - 5pm Special Needs: Yes # DN14619FL Flipczak, Donnie • Inhalation Sedation # DN8995FL Switkes, Michael English, Arabic, Russian, Spanish NPI: 1316043474 LIC: DN14619FL # DN23007 Rivera, Lina NPI: 1609883172 LIC: DN8995FL M-T 10am - 5pm # DN14864 Henry, Stephen NPI: 1760908743 LIC: DN23007 # DN19286 Rand, Matthew # EV263947 NPI: 1851455117 LIC: DN14864 # DN20475 Santiago, Germaine NPI: 1740407030 LIC: DN19286 Pediatric Smiles, Inc NPI LIC: # FQHC013509 : 1922341460 DN20475 CERTIFICATIONS: 2255 Dunn Ave Ste 700 # DN24155 Trivedi, Sujay • General Anesthesia Community Health Jacksonville, FL 32218 Northwest Florida NPI: 1356909352 LIC: DN24155 (904) 751-5126 # EV517938 1295 W. Fairfield Dr # DN21066 Uzunova-Dimova, Special Needs: Yes UF Oral Maxillofacial Pensacola, FL 32501 Kalina English, Spanish 653 W. 8Th St. (850) 912-8880

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 14 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Special Needs: Yes NPI: 1770885436 LIC: DN22386 NPI: 1093956088 LIC: DN19082 Mark L Johnson, DDS, PA English # DN24733 Mardini, 215 South Third Street # FQHC014990 M-T 8am - 5pm Joseph-Charles Flagler Beach, FL 32136 W-F 8am - 5pm Community Health General Dentist servicing as: (386) 439-9688 # DN8846 Copenhaver, Lawrence Northwest Florida Endodontics Special Needs: Yes General Dentist servicing as: 501 Church Street NPI: 1245613439 LIC: DN24733 English Pediatric Dentistry Century, FL 32535 # DN22386 Watkins, Jacinta M-T 8am - 4pm NPI: 1366409807 LIC: DN8846 healthcarewithinreach.org NPI: 1770885436 LIC: DN22386 # DN15035 Johnson, Mark (850) 724-4054 # DN23413 Digby, Gregory General Dentist servicing as: Special Needs: Yes NPI: 1437646080 LIC: DN23413 # 013222 Endodontics English, Spanish NPI: 1154443513 LIC: DN15035 # DN19082 Hernandez, Gabriel Cordova Dental Center # DN8846 Copenhaver, Lawrence 5120 Bayou Blvd, Ste #4 NPI: 1093956088 LIC: DN19082 General Dentist servicing as: FRANKLIN COUNTY Pensacola, FL 32503 # DN24733 Mardini, Pediatric Dentistry (850) 477-3188 Joseph-Charles NPI: 1366409807 LIC: DN8846 DENTIST Special Needs: Yes General Dentist servicing as: # DN23413 Digby, Gregory English, Farsi, Vietnamese Endodontics # FQHC015406 NPI: 1437646080 LIC: DN23413 M-T 9am - 5pm NPI: 1245613439 LIC: DN24733 PanCare of Florida # DN24733 Mardini, W-F 9am - 5pm # DN22386 Watkins, Jacinta 106 Ne 5Th St Joseph-Charles # DN11910 Schildroth, Charles Carrabelle, FL 32322 NPI: 1770885436 LIC: DN22386 General Dentist servicing as: NPI: 1740334655 LIC: DN11910 (850) 697-5000 Endodontics # FQHC014964 Special Needs: No NPI: 1245613439 LIC: DN24733 FLAGLER COUNTY Community Health English # DN22386 Watkins, Jacinta Northwest Florida DENTIST M-T 8am - 5pm NPI: 1770885436 LIC: DN22386 470 S. Hwy 29 Ste B W-F 8am - 5pm Cantonment, FL 32533 # DN10365FL Barry, Steven # FQHC022628 # CHC10022 (850) 780-0111 NPI: 1497826531 LIC: DN10365FL Community Health DOH - Flagler County Health Special Needs: Yes Department # DN19128 Claussen, Meghann English, Spanish Northwest Florida 301 Dr Carter Bvd 6021 Industrial Blvd NPI: 1336454651 LIC: DN19128 M-T 7:30 am - 4pm Bunnell, FL 32110 Century, FL 32535 # DN25097 Haynam, Eric W-F 7:30 am - 4pm (386) 437-7350 (850) 724-4064 NPI LIC: # DN8846 Copenhaver, Lawrence Special Needs: Yes : 1043688831 DN25097 Special Needs: Yes General Dentist servicing as: English, Russian, Creoles and # DN13094 Hudon, Richard English Pediatric Dentistry Pidgins English-based(other), M-T 7:30 am - 4pm NPI: 1245336031 LIC: DN13094 NPI: 1366409807 LIC: DN8846 Spanish W-F 7:30 am - 4pm # DN21740 Moffa, Michelle M-T 8am - 4:30 pm # DN23413 Digby, Gregory # DN8846 Copenhaver, Lawrence W-F 8am - 4:30 pm General Dentist servicing as: NPI: 1437646080 LIC: DN23413 General Dentist servicing as: NPI: 1841277407 LIC: DN21740 # DN16666 Bey, Frances # DN24733 Mardini, Pediatric Dentistry NPI: 1760458798 LIC: DN16666 # DN19745 Norton, Andrew Joseph-Charles NPI: 1366409807 LIC: DN8846 NPI: 1861754020 LIC: DN19745 # DN12581 Ramirez, Benigno General Dentist servicing as: # DN23413 Digby, Gregory Endodontics NPI: 1043230295 LIC: DN12581 # DN18871 Pate, Sheena NPI: 1437646080 LIC: DN23413 NPI: 1245613439 LIC: DN24733 General Dentist servicing as: # DN19082 Hernandez, Gabriel # 010967 Pediatric Dentistry # DN22386 Watkins, Jacinta

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 15 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1215255880 LIC: DN18871 (850) 875-9502 GLADES COUNTY W-F 8am - 5pm Special Needs: Yes # DN21660 Piorkowski, Gary # DN10365FL Barry, Steven English, Spanish General Dentist servicing as: DENTIST NPI: 1497826531 LIC: DN10365FL M-T 8am - 5pm NPI: 1699705434 LIC: DN21660 # DN19128 Claussen, Meghann W-F 8am - 5pm # FQHC011249 # DN23084 Santos, Iris NPI: 1336454651 LIC: DN19128 # DN21203 Chou, Victor Florida Community Health NPI: 1487875233 LIC: DN23084 # DN25097 Haynam, Eric General Dentist servicing as: Centers, Inc. # HAD69 Smith, Amy NPI: 1558741249 LIC: DN21203 1021 Health Park Drive NPI: 1043688831 LIC: DN25097 NPI: 1831209899 LIC: HAD69 # DN14565 Dudley, Alexander* Moore Haven, FL 33471 # DN13094 Hudon, Richard (863) 946-0405 # DN18668 Van Dyke, General Dentist servicing as: NPI: 1245336031 LIC: DN13094 Special Needs: Yes Kanyaratana NPI: 1518975499 LIC: DN14565 # DN21740 Moffa, Michelle English, Spanish, Creoles and NPI: 1003122656 LIC: DN18668 General Dentist servicing as: # DN24185 Durham, Dominique Pidgins French-based(other), # HAD65 Wilhite, Rhonda General Dentist servicing as: French NPI: 1841277407 LIC: DN21740 General Dentist servicing as: NPI: 1053972257 LIC: DN24185 M-T 8am - 5pm # DN19745 Norton, Andrew NPI: 1952496341 LIC: HAD65 W 8am - 6pm, Th 8am - 5pm, F # DN24876FL NPI: 1861754020 LIC: DN19745 Soekirman, Lauren 8am - 4pm # DN22573 Williams, Sean General Dentist servicing as: # DN18871 Pate, Sheena # DN20720 Blackwood, Alberto NPI: 1306376512 LIC: DN22573 NPI: 1508489238 LIC: DN24876FL General Dentist servicing as: NPI: 1487057303 LIC: DN20720 Pediatric Dentistry GADSDEN COUNTY # FQHC011429 # DN13607 Morales, Carlos NPI: 1215255880 LIC: DN18871 NPI: 1457310559 LIC: DN13607 DENTIST Neighborhood Medical # DN21660 Piorkowski, Gary Center # DN14000 Naryshkin, George General Dentist servicing as: # 014905 604 E. 5Th Ave NPI: 1730395773 LIC: DN14000 NPI: 1699705434 LIC: DN21660 Havana, FL 32333 Dental Workz of Quincy # DN23400 Pham, Emily # DN23084 Santos, Iris (850) 539-8222 314 E. Jefferson St NPI: 1851947568 LIC: DN23400 Special Needs: Yes NPI: 1487875233 LIC: DN23084 Quincy, FL 32351 English, Spanish, Creoles and # DN13771 Sanchez, Armando # HAD69 Smith, Amy (850) 618-0114 Pidgins English-based(other) NPI: 1992764930 LIC: DN13771 NPI: 1831209899 LIC: HAD69 Special Needs: Yes M-T 8am - 6pm # DN13207 Zayas, Alida # DN18668 Van Dyke, English, Spanish W-F 8am - 6pm M-T 9am - 6pm NPI: 1639148968 LIC: DN13207 Kanyaratana # HAD84 Hall, Shai W 12pm - 6pm, Th 9am - 6pm, F NPI: 1003122656 LIC: DN18668 NPI: 1013043637 LIC: HAD84 GULF COUNTY 9am - 11:30 am # HAD65 Wilhite, Rhonda # DN21433 Iduate Banobre, # DN21408 Howard, Enrique DENTIST General Dentist servicing as: Yolanda General Dentist servicing as: NPI: 1952496341 LIC: HAD65 NPI: 1598140618 LIC: DN21433 NPI: 1639540446 LIC: DN21408 # FQHC014254 # DN22573 Williams, Sean # DN20236 Laing, Christopher PanCare of Florida NPI: 1306376512 LIC: DN22573 # FQHC015507 General Dentist servicing as: 2475 Garrison Ave Jessie Furlow Medical Pediatric Dentistry Port Saint Joe, FL 32456 # FQHC014285 Center NPI: 1356696272 LIC: DN20236 (850) 229-1043 PanCare of Florida 1249 Strong Rd # DN18939 Thiry, Warren Special Needs: Yes 807 W. Hwy 22 Quincy, FL 32351 NPI: 1477871697 LIC: DN18939 English, Spanish Wewahitchka, FL 32465 www.northfloridamedicalcenters. M-T 8am - 5pm org PANCAREFL.ORG

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 16 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

(850) 639-2028 DENTIST General Dentist servicing as: # HAD79 Cocchieri, Richard* Special Needs: Yes Pediatric Dentistry General Dentist servicing as: English, Spanish # FQHC010736 NPI: 1497887863 LIC: DN16346 Pediatric Dentistry M-T 8am - 5pm Central Florida Health Care # DN20914 Hackstie, Joseph NPI: 1578685491 LIC: HAD79 W-F 8am - 5pm Inc NPI: 1932508405 LIC: DN20914 # HAD100 Miles, Kenneth* # DN10365FL Barry, Steven 121 Kd Revell Rd # DN18154 Mckenzie, Karen NPI: 1063563724 LIC: HAD100 NPI: 1497826531 LIC: DN10365FL Wauchula, FL 33873 General Dentist servicing as: # DN11385 Traul Jr., Robert* (863) 767-0696 Pediatric Dentistry # DN19128 Claussen, Meghann General Dentist servicing as: Special Needs: Yes NPI: 1336454651 LIC: DN19128 NPI: 1821286287 LIC: DN18154 Pediatric Dentistry English, Spanish, Creoles and # HAD33 Modaff, Michelle NPI: 1982734257 LIC: DN11385 # DN25097 Haynam, Eric Pidgins English-based(other), NPI: 1043688831 LIC: DN25097 French NPI: 1497768295 LIC: HAD33 # FQHC011248 M-T 7:30 am - 5pm # DN21596 Nagib, Marie Claire # DN13094 Hudon, Richard Florida Community Health W-F 7:30 am - 5pm NPI: 1225414907 LIC: DN21596 NPI: 1245336031 LIC: DN13094 Centers, Inc. # DN22773 Aiyede, Onize # DN21740 Moffa, Michelle # DN22245 Rubin, Joslyn 315 S. W C Owen Ave General Dentist servicing as: General Dentist servicing as: General Dentist servicing as: Clewiston, FL 33440 Pediatric Dentistry Pediatric Dentistry (863) 983-7813 NPI: 1841277407 LIC: DN21740 NPI: 1306295712 LIC: DN22773 NPI: 1861940850 LIC: DN22245 Special Needs: Yes # DN19745 Norton, Andrew # HAD80 Antony, Archana # DN6990 Seifert, Thomas English, Spanish NPI: 1861754020 LIC: DN19745 General Dentist servicing as: General Dentist servicing as: M 8am - 5pm, T 8am - 6pm # DN18871 Pate, Sheena Pediatric Dentistry Pediatric Dentistry W-Th 8am - 5pm NPI: 1851607766 LIC: HAD80 General Dentist servicing as: NPI: 1255654232 LIC: DN6990 # DN20720 Blackwood, Alberto Pediatric Dentistry # DN23942 Cameron, Casey # DN15069 Suri, Niki NPI: 1487057303 LIC: DN20720 NPI: 1215255880 LIC: DN18871 NPI: 1548758147 LIC: DN23942 NPI: 1316129182 LIC: DN15069 # DN13607 Morales, Carlos # DN21660 Piorkowski, Gary # HAD79 Cocchieri, Richard # DN17405 Ward, Tasha NPI: 1457310559 LIC: DN13607 General Dentist servicing as: General Dentist servicing as: NPI: 1528087871 LIC: DN17405 # DN14000 Naryshkin, George NPI: 1699705434 LIC: DN21660 Pediatric Dentistry NPI: 1578685491 LIC: HAD79 NPI: 1730395773 LIC: DN14000 # DN23084 Santos, Iris HENDRY COUNTY # DN23400 Pham, Emily NPI: 1487875233 LIC: DN23084 # HAD92 Coello, Marla DENTIST NPI: 1891833620 LIC: HAD92 NPI: 1851947568 LIC: DN23400 # HAD69 Smith, Amy # DN13771 Sanchez, Armando NPI: 1831209899 LIC: HAD69 # DN12668 Congote, Luis # CHC014622 General Dentist servicing as: NPI: 1992764930 LIC: DN13771 # DN18668 Van Dyke, DOH - Hendry County Pediatric Dentistry Kanyaratana (School Based) # DN13207 Zayas, Alida NPI: 1679774426 LIC: DN12668 NPI: 1003122656 LIC: DN18668 1140 Pratt Blvd NPI: 1639148968 LIC: DN13207 # DN13255 Cooper, Angela Labelle, FL 33935 # HAD65 Wilhite, Rhonda # 014861 General Dentist servicing as: (863) 674-4041 General Dentist servicing as: Pediatric Dentistry Special Needs: Yes Ileana Moya, Inc NPI: 1952496341 LIC: HAD65 NPI: 1912994914 LIC: DN13255 English, Spanish 872 W. Sugarland Hwy # DN22573 Williams, Sean # DN23944 Espinosa-Batista, M-T 8am - 5pm Clewiston, FL 33440 NPI: 1306376512 LIC: DN22573 Claudia W-F 8am - 5pm (863) 983-5600

NPI: 1447747449 LIC: DN23944 # DN11663 Bridges, Catherine* Special Needs: Yes HARDEE COUNTY English, Spanish # DN16346 Gomara, Denise NPI: 1659309821 LIC: DN11663

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 17 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

• Inhalation Sedation M-T 10am - 5:30 pm # DN19998 Nazco-Batista, Maria NPI: 1548758147 LIC: DN23942 W-F 10am - 5:30 pm # DN20707 Painter, Lisa General Dentist servicing as: # HAD79 Cocchieri, Richard # DN20337 Moya, Ileana NPI: 1083031926 LIC: DN20707 Pediatric Dentistry General Dentist servicing as: NPI: 1093050676 LIC: DN19998 General Dentist servicing as: # DN13891 Peralta, Jose Pediatric Dentistry Pediatric Dentistry CERTIFICATIONS: NPI: 1578685491 LIC: HAD79 NPI: 1962462036 LIC: DN13891 NPI: 1710319140 LIC: DN20337 • Inhalation Sedation # HAD92 Coello, Marla # DN22607 Rotaru, Ion # DN20707 Painter, Lisa HERNANDO COUNTY General Dentist servicing as: NPI: 1891833620 LIC: HAD92 NPI: 1083031926 LIC: DN20707 Pediatric Dentistry # DN12668 Congote, Luis # DN13891 Peralta, Jose DENTIST NPI: 1558899658 LIC: DN22607 General Dentist servicing as: NPI: 1962462036 LIC: DN13891 # DN19476 Thomas, Kelly Pediatric Dentistry # FQHC016313 NPI: 1679774426 LIC: DN12668 NPI: 1821374828 LIC: DN19476 # DN22607 Rotaru, Ion Premier Community General Dentist servicing as: # DN13255 Cooper, Angela HealthCare Group, Inc. # FQHC016314 Pediatric Dentistry General Dentist servicing as: 300 S. Main St Premier Community NPI: 1558899658 LIC: DN22607 Pediatric Dentistry Brooksville, FL 34601 HealthCare Group, Inc. # DN19476 Thomas, Kelly NPI: 1912994914 LIC: DN13255 (352) 518-2000 7551 Forest Oaks Blvd NPI: 1821374828 LIC: DN19476 # DN23944 Espinosa-Batista, Special Needs: Yes Spring Hill, FL 34606 Claudia English, Spanish HIGHLANDS COUNTY (352) 518-2000 NPI: 1447747449 LIC: DN23944 M 7am - 7pm, T 7am - 4pm Special Needs: Yes W-F 7am - 4pm # DN16346 Gomara, Denise English, Spanish DENTIST General Dentist servicing as: # DN11556 Baker, Wayne M 7am - 7pm, T 7am - 4pm Pediatric Dentistry NPI: 1699833947 LIC: DN11556 W-F 7am - 4pm # CHC7920 NPI: 1497887863 LIC: DN16346 Central Florida Health Care, # DN14806 Barinas-Duval, # DN11556 Baker, Wayne Inc # DN20914 Hackstie, Joseph Froilan NPI: 1699833947 LIC: DN11556 NPI: 1932508405 LIC: DN20914 General Dentist servicing as: 950 County Road 17-A West # DN14806 Barinas-Duval, Pediatric Dentistry Avon Park, FL 33825 # DN18154 Mckenzie, Karen Froilan NPI: 1699748442 LIC: DN14806 (866) 234-8534 General Dentist servicing as: General Dentist servicing as: Special Needs: Yes Pediatric Dentistry CERTIFICATIONS: Pediatric Dentistry • Inhalation Sedation Spanish, English, Creoles and NPI: 1821286287 LIC: DN18154 NPI: 1699748442 LIC: DN14806 Pidgins English-based(other), # DN23246 Boodhoo, Amanda # HAD33 Modaff, Michelle CERTIFICATIONS: French General Dentist servicing as: • Inhalation Sedation M-T 7:30 am - 4:30 pm NPI: 1497768295 LIC: HAD33 Pediatric Dentistry # DN23246 Boodhoo, Amanda W-F 7:30 am - 4:30 pm # DN21596 Nagib, Marie Claire NPI: 1639531460 LIC: DN23246 General Dentist servicing as: # DN22773 Aiyede, Onize NPI: 1225414907 LIC: DN21596 # HAD27 Genho, Beth Pediatric Dentistry General Dentist servicing as: # DN22245 Rubin, Joslyn NPI: 1942491154 LIC: HAD27 NPI: 1639531460 LIC: DN23246 Pediatric Dentistry General Dentist servicing as: # HAD27 NPI LIC: # DN17434FL McCullough, Ray Genho, Beth : 1306295712 DN22773 Pediatric Dentistry NPI: 1205996428 LIC: DN17434FL NPI: 1942491154 LIC: HAD27 # HAD80 Antony, Archana NPI: 1861940850 LIC: DN22245

# DN19998 Nazco-Batista, Maria # DN15171FL Hassan, Rawa General Dentist servicing as: # DN6990 Seifert, Thomas Pediatric Dentistry General Dentist servicing as: NPI: 1417127614 LIC: DN15171FL General Dentist servicing as: Pediatric Dentistry NPI: 1851607766 LIC: HAD80 # DN17434FL McCullough, Ray Pediatric Dentistry NPI: 1093050676 LIC: DN19998 # DN23942 Cameron, Casey NPI: 1255654232 LIC: DN6990 NPI: 1205996428 LIC: DN17434FL 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 18 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN15069 Suri, Niki General Dentist servicing as: NPI: 1619956323 LIC: DN17335FL Tampa, FL 33612 Endodontics NPI: 1316129182 LIC: DN15069 # DN23847 Khan, Adiba (813) 331-4578 NPI: 1235255845 LIC: DN11501 Special Needs: Yes # DN17405 Ward, Tasha NPI: 1649638172 LIC: DN23847 English, Spanish NPI: 1528087871 LIC: DN17405 # 011547 # DN22197 Khatib, Adel M-T 8am - 5pm Brandon Mall Dental PA General Dentist servicing as: W-F 8am - 5pm # CHC10101 Endodontics 675 Brandon Town Center Mall # DN10234 Battle, Michael DOH - Highlands County NPI: 1235582503 LIC: DN22197 Brandon, FL 33511 Health Department NPI: 1124042783 LIC: DN10234 (813) 681-8600 # DN24131 Krupnov, Vera 7205 S. George Blvd CERTIFICATIONS: Special Needs: Yes NPI: 1386202984 LIC: DN24131 Sebring, FL 33875 • Inhalation Sedation English, Russian, Spanish (863) 382-7257 # DN20101 Licina, Zeljka M-T 11am - 8pm # 018497 Special Needs: Yes NPI: 1013263292 LIC: DN20101 W-F 11am - 8pm Cordica Dental Designs English, Spanish # DN24055 Lodhi, Hafsa # DN22246 Antezana, Mauricio M-T 8am - 5pm 104 E Fletcher Ave NPI: 1588023584 LIC: DN24055 W-F 8am - 5pm General Dentist servicing as: Tampa, FL 33612 Pediatric Dentistry # DN19470 Maniglia, Marielba (813) 661-1800 # DN11663 Bridges, Catherine* NPI: 1063876399 LIC: DN22246 NPI: 1063793644 LIC: DN19470 Special Needs: Yes NPI: 1659309821 LIC: DN11663 # DN21079 Arnedo, Johanna # 24529 Moini, Marshall English, Spanish # HAD53 Morris-Zamora, M-T 10am - 5pm General Dentist servicing as: NPI: 1437700937 LIC: 24529 Thomas* Pediatric Dentistry W-F 10am - 5pm # DN23402 Montenegro, Christian NPI: 1548396385 LIC: HAD53 NPI: 1104213909 LIC: DN21079 # DN15530 Perks, Elizabeth NPI: 1144714445 LIC: DN23402 # DN11385 Traul Jr., Robert* CERTIFICATIONS: General Dentist servicing as: General Dentist servicing as: • Inhalation Sedation # DN23652 Ospina, Luz Endodontics Pediatric Dentistry # DN17412 Atkinson, William General Dentist servicing as: NPI: 1336242296 LIC: DN15530 NPI: 1982734257 LIC: DN11385 General Dentist servicing as: Oral Surgery CERTIFICATIONS: Pediatric Dentistry NPI: 1881181501 LIC: DN23652 • Inhalation Sedation HILLSBOROUGH COUNTY NPI: 1942360862 LIC: DN17412 # DN23021 Riboul, Sandrine # 019660 CERTIFICATIONS: DENTIST NPI: 1609227057 LIC: DN23021 • Inhalation Sedation Dental Excellence Partners, CERTIFICATIONS: # DN17123 Bravo, Raquel • Inhalation Sedation LLC # 022643 4144 N. Armenia Ave. #150 NPI: 1538312525 LIC: DN17123 # DN23007 Rivera, Lina Brandon Family Dental Care, Tampa, FL 33607 # DN21812 Cabrera, Rene NPI: 1760908743 LIC: DN23007 LLC (813) 575-1635 227 N Knights Ave General Dentist servicing as: # DN20475 Santiago, Germaine Special Needs: Yes Pediatric Dentistry Brandon, FL 33510 NPI: 1922341460 LIC: DN20475 English, Spanish NPI: 1518313675 LIC: DN21812 (813) 685-5611 M-T 8am - 5pm # DN21066 Uzunova-Dimova, Special Needs: Yes # DN24313FL Evans, Mana W-F 8am - 5pm Kalina English, Spanish NPI: 1750818712 LIC: DN24313FL General Dentist servicing as: # DN14815 Alcequiez, Zeneyda M-T 8am - 6pm # DN24375FL Gaton Molina, Sarah Pediatric Dentistry NPI: 1124241989 LIC: DN14815 # DN12116 Mason, John* NPI: 1245540947 LIC: DN21066 NPI: 1538713979 LIC: DN24375FL # DN23321 Aleman, Jose NPI: 1851370456 LIC: DN12116 # DN20710 Gonzalez, Kely # EV721947 NPI: 1770061020 LIC: DN23321 # DN11501 Parker, David* NPI: 1952717027 LIC: DN20710 Citi Dental of Tampa # DN21645 Baez Henry, # DN17335FL Guilarte, Rhona Carlianette 9309 N Florida Ave Ste 111

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 19 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1235594961 LIC: DN21645 # DN24672 Pilarte, Graciela # DN23695 Cruz, Yanet* English, Spanish M-T 8am - 5pm # DN22998 Boeras Garcia, Suibel NPI: 1548691017 LIC: DN24672 NPI: 1508225376 LIC: DN23695 W-F 8am - 5pm NPI: 1063939890 LIC: DN22998 # DN22255 Rajschmir, Silvina # DN24481 Defaus Fernandez, # DN23341 Allawnha, Abdullah # DN15630 Cano, Lourdes General Dentist servicing as: Beatriz* NPI: 1023558087 LIC: DN24481 NPI: 1558852392 LIC: DN23341 NPI: 1093867947 LIC: DN15630 Pediatric Dentistry NPI: 1679977896 LIC: DN22255 # DN23705 Diaz Valle, Orlando* # DN19709 Biandudi, Odessa # DN21572 Carballo, Mauro # DN22999 Reyes, Christina NPI: 1457717290 LIC: DN23705 NPI: 1679835599 LIC: DN19709 NPI: 1508200635 LIC: DN21572 CERTIFICATIONS: NPI: 1679931000 LIC: DN22999 # DN25261FL Montero, Yenisey* # DN12668 Congote, Luis • Inhalation Sedation # DN11150 Reyes, Miguel NPI: 1740786599 LIC: DN25261FL General Dentist servicing as: # DN22998 Boeras Garcia, Suibel Pediatric Dentistry NPI: 1407948482 LIC: DN11150 # DN23899 Moya, Yudit* NPI: 1063939890 LIC: DN22998 NPI: 1679774426 LIC: DN12668 # DN24069 Rodriguez Gonzalez, NPI: 1144793233 LIC: DN23899 # DN18731 Brawley, Carmen David # DN23695 Cruz, Yanet # DN24672 Pilarte, Graciela* NPI: 1689803132 LIC: DN18731 NPI: 1548798960 LIC: DN24069 NPI: 1508225376 LIC: DN23695 NPI: 1548691017 LIC: DN24672 # DN12680 Dos Passos II, John # DN19389 Sanchez, Arnaldo # DN24481 Defaus Fernandez, # DN22255 Rajschmir, Silvina* NPI: 1265411953 LIC: DN12680 NPI: 1831486844 LIC: DN19389 Beatriz General Dentist servicing as: CERTIFICATIONS: NPI: 1023558087 LIC: DN24481 # DN24107 Pediatric Dentistry Serhan Lopez, Nayef • Inhalation Sedation # DN23705 Diaz Valle, Orlando NPI: 1184282550 LIC: DN24107 NPI: 1679977896 LIC: DN22255 # DN23108 Farrah, Rose NPI: 1457717290 LIC: DN23705 # DN17332 Simon, Gelsys* # DN17332 Simon, Gelsys NPI: 1588169254 LIC: DN23108 # DN24104 Gonzalez Junco, Luis NPI: 1629154299 LIC: DN17332 NPI: 1629154299 LIC: DN17332 # DN19638 Immadi, Lakshmi NPI: 1447819396 LIC: DN24104 # DN21495 Streett, Rosario # 020192-HOSP1 NPI: 1083988901 LIC: DN19638 # DN23700 Gonzalez, Carmen NPI: 1801230768 LIC: DN21495 Florida Dental Team LLC (By # DN22776 Maduro, Ledesha NPI: 1285110718 LIC: DN23700 # DN24393 Vimo, Belen Referral Only) NPI: 1174982458 LIC: DN22776 # DN23529 Gonzalez, Giovanni NPI: 1144879925 LIC: DN24393 10909 West Linebaugh Ave, Ste # DN17676 Malik, Shazia NPI: 1417436189 LIC: DN23529 102 # DN23764 Wilkins, Lorena NPI: 1811077621 LIC: DN17676 Tampa, FL 33626 # DN19802 Hernandez, David* NPI: 1669950192 LIC: DN23764 CERTIFICATIONS: (813) 774-6003 NPI: 1245593896 LIC: DN19802 • Inhalation Sedation # 022656 Special Needs: Yes # DN15142 Reed, Samantha # DN19522 Hernandez, English, Spanish Dental Excellence Partners, Stephanie* General Dentist servicing as: # DN14994 Berk, Lars* LLC Pediatric Dentistry NPI: 1669751871 LIC: DN19522 807 S. Parson Ave NPI: 1336251487 LIC: DN14994 NPI: 1104042456 LIC: DN15142 # DN23644 Martinez Morales, Brandon, FL 33511 # DN19359 Dorsey, Cassandra* CERTIFICATIONS: Lesner (813) 527-0245 NPI: 1629363940 LIC: DN19359 • Inhalation Sedation NPI: 1619453743 LIC: DN23644 Special Needs: Yes # DN19801 Wheeley, Amrita # DN25261FL Montero, Yenisey English, Spanish # 011013 NPI: 1649533605 LIC: DN19801 NPI: 1740786599 LIC: DN25261FL M-T 8am - 5pm Great Expressions Dental W-F 8am - 5pm # 010534 # DN22889 Mostatabzadeh, Amir Centers # DN21645 Baez Henry, 825 W. Martin Luther King Blvd Guillermo Porro, D.M.D., P.A. NPI: 1457883019 LIC: DN22889 Carlianette Tampa, FL 33603 7059 West Waters Ave # DN23899 Moya, Yudit NPI: 1235594961 LIC: DN21645 (813) 237-1982 Tampa, FL 33634 NPI: 1144793233 LIC: DN23899 Special Needs: Yes porrodental.com

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 20 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

(813) 889-8599 NPI: 1629326277 LIC: DN15132 English, Spanish Sylmar Family Dental Special Needs: Yes M-T 7:30 am - 5pm # DN22779 Ordonez, Margaret Practice English, Spanish W-F 7:30 am - 5pm General Dentist servicing as: 15283 Amberly Dr M-T 8:30 am - 5pm Pediatric Dentistry # DN20880 Brachowicz, Maria* Tampa, FL 33647 # DN10372 Porro, Guillermo* NPI: 1972032795 LIC: DN22779 NPI: 1770992117 LIC: DN20880 (813) 898-2523 General Dentist servicing as: Special Needs: No # HAD70 Simeoni, Anna # DN20318 Cisneros, Aura* Pediatric Dentistry English, Spanish NPI: 1396817797 LIC: HAD70 NPI: 1356346340 LIC: DN20318 NPI: 1346309689 LIC: DN10372 M-T 8am - 5pm CERTIFICATIONS: # FQHC010832 # DN24735 Gutierrez, Alexis # 011149 • Inhalation Sedation Plant City Family Care NPI: 1710025150 LIC: DN24735 Keystone Dental Excellence # DN22362 Colonneaux, Amanda* 801 E. Baker Street NPI: 1073967519 LIC: DN22362 8325 Gunn Hwy # FQHC010697 Plant City, FL 33563 Tampa, FL 33626 # DN15132 Dietz, Rodney* Tampa Family Health (813) 653-6100 (813) 792-0041 NPI: 1629326277 LIC: DN15132 Special Needs: Yes Centers Special Needs: No English, Spanish # DN22779 Ordonez, Margaret* 5611 Sheldon Rd English, Spanish M 7:30 am - 5pm, T 7:30 am - General Dentist servicing as: Tampa, FL 33615 M-T 7am - 4pm 6pm Pediatric Dentistry (813) 397-5300 # DN15969 Reinhart, Joel W 7:30 am - 7pm, Th 7:30 am - NPI: 1972032795 LIC: DN22779 Special Needs: Yes General Dentist servicing as: 8pm, F 7:30 am - 9pm English, Spanish, French (T) # HAD70 Simeoni, Anna* Endodontics # DN20880 Brachowicz, Maria* M-T 8am - 5pm NPI: 1396817797 LIC: HAD70 NPI: 1033208392 LIC: DN15969 W-F 8am - 5pm NPI: 1770992117 LIC: DN20880 CERTIFICATIONS: # DN25579FL Azer, Peter # DN20318 Cisneros, Aura* # FQHC010830 • Inhalation Sedation NPI: 1396240875 LIC: DN25579FL NPI: 1356346340 LIC: DN20318 Suncoast Mobile Dental Van # FQHC010979 CERTIFICATIONS: 2814 14Th Ave Se # DN23246 Boodhoo, Amanda Palm River Community • Inhalation Sedation Ruskin, FL 33570 General Dentist servicing as: Health Center # DN22362 Colonneaux, Amanda* (813) 653-6100 Pediatric Dentistry Special Needs: No NPI: 1639531460 LIC: DN23246 7728 Palm River Rd NPI: 1073967519 LIC: DN22362 Tampa, FL 33619 English # DN25247 Brown, Jordan # DN15132 Dietz, Rodney* M-T 8am - 5pm (813) 630-3635 NPI: 1982221339 LIC: DN25247 NPI: 1629326277 LIC: DN15132 Special Needs: Yes W-F 8am - 5pm # DN22253 Carter, Jade English, Spanish # DN22779 Ordonez, Margaret* # DN20880 Brachowicz, Maria General Dentist servicing as: NPI: 1487968467 LIC: DN22253 M-T 7:30 am - 5pm NPI: 1770992117 LIC: DN20880 W-F 7:30 am - 5pm Pediatric Dentistry # DN13067 Gamble, Isolda # DN20318 NPI: 1972032795 LIC: DN22779 Cisneros, Aura # DN20880 Brachowicz, Maria NPI: 1992764484 LIC: DN13067 NPI: 1356346340 LIC: DN20318 NPI: 1770992117 LIC: DN20880 # HAD70 Simeoni, Anna* # DN4964 Graddy, Nathan CERTIFICATIONS: NPI: 1396817797 LIC: HAD70 # DN20318 Cisneros, Aura • Inhalation Sedation NPI: 1225318025 LIC: DN4964

NPI: 1356346340 LIC: DN20318 # FQHC010829 # DN15132 Dietz, Rodney # DN19926 Guerra, William General Dentist servicing as: CERTIFICATIONS: Ruskin Health Center NPI: 1629326277 LIC: DN15132 • Inhalation Sedation Pediatric Dentistry 2814 14Th Ave Se # HAD70 Simeoni, Anna # DN22362 Colonneaux, Amanda NPI: 1861749459 LIC: DN19926 Ruskin, FL 33570 NPI: 1396817797 LIC: HAD70 NPI: 1073967519 LIC: DN22362 # DN22578 Healey, Kristyn (813) 653-6100 # DN15132 Dietz, Rodney Special Needs: Yes # EV825445 NPI: 1619401205 LIC: DN22578

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 21 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23345 Ivanov, Simona NPI: 1396240875 LIC: DN25579FL # DN23805 Najafi, Gina NPI: 1528474822 LIC: DN20612 NPI: 1861987752 LIC: DN23345 # DN23246 Boodhoo, Amanda NPI: 1699259291 LIC: DN23805 # DN23286 Joseph, Jobin

# DN24211 Jacas, Jose General Dentist servicing as: # DN24498 Popek, Barbara NPI: 1669883856 LIC: DN23286 Pediatric Dentistry NPI: 1669032603 LIC: DN24211 NPI: 1740320993 LIC: DN24498 # DN18068 Le, Jade NPI: 1639531460 LIC: DN23246 # DN20612 Jean, Darlene # DN15880 Tibby, Tamara-Kay NPI: 1154541845 LIC: DN18068 # DN25247 Brown, Jordan General Dentist servicing as: NPI: 1508893850 LIC: DN15880 CERTIFICATIONS: NPI: 1982221339 LIC: DN25247 • Inhalation Sedation Pediatric Dentistry CERTIFICATIONS: • Conscious Sedation NPI: 1528474822 LIC: DN20612 # DN22253 Carter, Jade • Board Certification # DN23805 Najafi, Gina # DN23286 Joseph, Jobin NPI: 1487968467 LIC: DN22253 # FQHC1124065 NPI: 1699259291 LIC: DN23805 NPI: 1669883856 LIC: DN23286 # DN13067 Gamble, Isolda Tampa Family Health # DN24498 Popek, Barbara # DN18068 Le, Jade NPI: 1992764484 LIC: DN13067 Centers, Inc NPI: 1740320993 LIC: DN24498 NPI: 1154541845 LIC: DN18068 # DN4964 Graddy, Nathan 12410 N Nebraska Ave # DN15880 Tibby, Tamara-Kay CERTIFICATIONS: NPI: 1225318025 LIC: DN4964 Tampa, FL 33612 • Inhalation Sedation NPI: 1508893850 LIC: DN15880 # DN19926 Guerra, William (813) 397-5300 • Conscious Sedation CERTIFICATIONS: General Dentist servicing as: Special Needs: No # DN17431 Leon, Ana • Board Certification Pediatric Dentistry English General Dentist servicing as: M-T 8am - 5pm NPI: 1861749459 LIC: DN19926 # FQHC012069 Pediatric Dentistry W-F 8am - 5pm NPI: 1578762332 LIC: DN17431 # DN22578 Healey, Kristyn Tampa Family Health # DN25579FL Azer, Peter CERTIFICATIONS: NPI: 1619401205 LIC: DN22578 Centers, Inc. NPI: 1396240875 LIC: DN25579FL • Inhalation Sedation # DN23345 Ivanov, Simona 6216 E. Sligh Ave # DN25247 Brown, Jordan Tampa, FL 33617 # DN23805 Najafi, Gina NPI: 1861987752 LIC: DN23345 (813) 397-5300 NPI: 1699259291 LIC: DN23805 NPI: 1982221339 LIC: DN25247 # DN24211 Jacas, Jose Special Needs: Yes # DN24498 Popek, Barbara # DN22253 Carter, Jade NPI: 1669032603 LIC: DN24211 English NPI: 1740320993 LIC: DN24498 NPI: 1487968467 LIC: DN22253 # DN20612 Jean, Darlene M-T 8am - 5pm # DN15880 Tibby, Tamara-Kay General Dentist servicing as: # DN13067 Gamble, Isolda W-F 8am - 5pm NPI: 1508893850 LIC: DN15880 Pediatric Dentistry NPI: 1992764484 LIC: DN13067 # DN25579FL Azer, Peter NPI: 1528474822 LIC: DN20612 CERTIFICATIONS: # DN4964 Graddy, Nathan NPI: 1396240875 LIC: DN25579FL • Board Certification # DN23286 Joseph, Jobin NPI: 1225318025 LIC: DN4964 # DN25247 Brown, Jordan NPI: 1669883856 LIC: DN23286 # FQHC022679 # DN25338FL Gray, Ericka NPI: 1982221339 LIC: DN25247 # DN18068 Le, Jade Tampa Family Health NPI: 1285244541 LIC: DN25338FL # DN22253 Carter, Jade NPI: 1154541845 LIC: DN18068 Centers, Inc # DN19926 Guerra, William NPI: 1487968467 LIC: DN22253 12085 W. Hillsborough Ave CERTIFICATIONS: General Dentist servicing as: # DN13067 Gamble, Isolda Tampa, FL 33635 • Inhalation Sedation Pediatric Dentistry • Conscious Sedation NPI: 1992764484 LIC: DN13067 (813) 866-0930 NPI: 1861749459 LIC: DN19926 Special Needs: Yes # DN17431 Leon, Ana # DN4964 Graddy, Nathan # DN23345 Ivanov, Simona English General Dentist servicing as: NPI: 1225318025 LIC: DN4964 NPI: 1861987752 LIC: DN23345 M-T 8am - 5pm Pediatric Dentistry # DN19926 Guerra, William W-F 8am - 5pm NPI: 1578762332 LIC: DN17431 # DN20612 Jean, Darlene General Dentist servicing as: CERTIFICATIONS: General Dentist servicing as: # DN25579FL Azer, Peter Pediatric Dentistry • Inhalation Sedation Pediatric 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 22 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1861749459 LIC: DN19926 English, Spanish NPI: 1578762332 LIC: DN17431 # DN22578 Healey, Kristyn M-T 8am - 5pm # DN22578 Healey, Kristyn CERTIFICATIONS: NPI: 1619401205 LIC: DN22578 W-F 8am - 5pm • Inhalation Sedation NPI: 1619401205 LIC: DN22578 # DN23345 Ivanov, Simona # DN25579FL Azer, Peter # DN23805 Najafi, Gina # DN23345 Ivanov, Simona NPI: 1861987752 LIC: DN23345 NPI: 1396240875 LIC: DN25579FL NPI: 1699259291 LIC: DN23805 NPI: 1861987752 LIC: DN23345 # DN24211 Jacas, Jose # DN25247 Brown, Jordan # DN24498 Popek, Barbara # DN24211 Jacas, Jose NPI: 1669032603 LIC: DN24211 NPI: 1982221339 LIC: DN25247 NPI: 1740320993 LIC: DN24498 NPI: 1669032603 LIC: DN24211 # DN20612 Jean, Darlene # DN22253 Carter, Jade # DN22607 Rotaru, Ion # DN20612 Jean, Darlene General Dentist servicing as: General Dentist servicing as: NPI: 1487968467 LIC: DN22253 Pediatric Dentistry General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry # DN13067 Gamble, Isolda NPI: 1528474822 LIC: DN20612 NPI: 1558899658 LIC: DN22607 NPI: 1528474822 LIC: DN20612 NPI: 1992764484 LIC: DN13067 # DN23286 Joseph, Jobin # DN15880 Tibby, Tamara-Kay # DN23286 Joseph, Jobin # DN4964 Graddy, Nathan NPI: 1669883856 LIC: DN23286 NPI: 1508893850 LIC: DN15880 NPI: 1669883856 LIC: DN23286 NPI: 1225318025 LIC: DN4964 CERTIFICATIONS: # DN18068 Le, Jade # DN18068 Le, Jade # DN25338FL Gray, Ericka • Board Certification NPI: 1154541845 LIC: DN18068 NPI: 1154541845 LIC: DN18068 NPI: 1285244541 LIC: DN25338FL CERTIFICATIONS: # FQHC10200 CERTIFICATIONS: • Inhalation Sedation # DN19926 Guerra, William • Inhalation Sedation Tampa Family Health • Conscious Sedation General Dentist servicing as: • Conscious Sedation Centers, Inc. # DN17431 Leon, Ana Pediatric Dentistry # DN17431 Leon, Ana 4620 N. 22Nd St General Dentist servicing as: NPI: 1861749459 LIC: DN19926 General Dentist servicing as: Tampa, FL 33610 Pediatric Dentistry # DN22578 Pediatric Dentistry Healey, Kristyn tampafamilyhc.com NPI: 1578762332 LIC: DN17431 NPI: 1578762332 LIC: DN17431 NPI: 1619401205 LIC: DN22578 (813) 397-5300 CERTIFICATIONS: CERTIFICATIONS: # DN23345 Ivanov, Simona Special Needs: Yes • Inhalation Sedation • Inhalation Sedation NPI: 1861987752 LIC: DN23345 Spanish, English # DN23805 Najafi, Gina # DN23805 Najafi, Gina M-T 8am - 5pm NPI: 1699259291 LIC: DN23805 # DN24211 Jacas, Jose W-F 8am - 5pm NPI: 1699259291 LIC: DN23805 NPI: 1669032603 LIC: DN24211 # DN24498 Popek, Barbara # DN25579FL Azer, Peter # DN24498 Popek, Barbara NPI: 1740320993 LIC: DN24498 # DN20612 Jean, Darlene NPI: 1396240875 LIC: DN25579FL NPI 1740320993 LIC: DN24498 : General Dentist servicing as: # DN22607 Rotaru, Ion # DN25247 Brown, Jordan # DN15880 Tibby, Tamara-Kay Pediatric Dentistry General Dentist servicing as: NPI: 1982221339 LIC: DN25247 NPI: 1508893850 LIC: DN15880 NPI: 1528474822 LIC: DN20612 Pediatric Dentistry NPI: 1558899658 LIC: DN22607 CERTIFICATIONS: # DN23286 Joseph, Jobin # DN22253 Carter, Jade • Board Certification NPI: 1669883856 LIC: DN23286 NPI: 1487968467 LIC: DN22253 # DN15880 Tibby, Tamara-Kay NPI: 1508893850 LIC: DN15880 # FQHC012070 # DN18068 Le, Jade # DN13067 Gamble, Isolda CERTIFICATIONS: NPI: 1154541845 LIC: DN18068 NPI: 1992764484 LIC: DN13067 Tampa Family Health • Board Certification Centers, Inc. CERTIFICATIONS: # DN4964 Graddy, Nathan 302 W. Fletcher Ave • Inhalation Sedation NPI: 1225318025 LIC: DN4964 # FQHC10201 • Conscious Sedation Tampa, FL 33612 # DN19926 Guerra, William Tampa Family Health tampafamilyhc.com # DN17431 Leon, Ana General Dentist servicing as: Centers, Inc. General Dentist servicing as: (813) 397-5305 Pediatric Dentistry 7814 N Dale Mabry Hwy Special Needs: Yes Pediatric Dentistry NPI: 1861749459 LIC: DN19926 Tampa, FL 33614

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 23 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

tampafamilyhc.com NPI: 1578762332 LIC: DN17431 General Dentist servicing as: NPI: 1487968467 LIC: DN22253 (813) 397-5300 Pediatric Dentistry CERTIFICATIONS: # DN13067 Gamble, Isolda Special Needs: Yes • Inhalation Sedation NPI: 1528474822 LIC: DN20612 NPI: 1992764484 LIC: DN13067 English, Spanish # DN23805 Najafi, Gina # DN23286 Joseph, Jobin M-T 8am - 5pm # DN4964 Graddy, Nathan NPI: 1699259291 LIC: DN23805 NPI: 1669883856 LIC: DN23286 W-F 8am - 5pm NPI: 1225318025 LIC: DN4964 # DN24498 Popek, Barbara # DN18068 Le, Jade # DN25579FL Azer, Peter # DN19926 Guerra, William NPI: 1740320993 LIC: DN24498 NPI: 1154541845 LIC: DN18068 NPI: 1396240875 LIC: DN25579FL General Dentist servicing as: CERTIFICATIONS: # DN22607 Rotaru, Ion Pediatric Dentistry # DN25247 Brown, Jordan • Inhalation Sedation General Dentist servicing as: NPI: 1861749459 LIC: DN19926 • Conscious Sedation NPI: 1982221339 LIC: DN25247 Pediatric Dentistry # DN17431 Leon, Ana # DN22578 Healey, Kristyn # DN22253 Carter, Jade NPI: 1558899658 LIC: DN22607 General Dentist servicing as: NPI: 1619401205 LIC: DN22578 NPI: 1487968467 LIC: DN22253 # DN15880 Tibby, Tamara-Kay Pediatric Dentistry # DN23345 Ivanov, Simona # DN13067 Gamble, Isolda NPI: 1508893850 LIC: DN15880 NPI: 1578762332 LIC: DN17431 NPI: 1861987752 LIC: DN23345 NPI: 1992764484 LIC: DN13067 CERTIFICATIONS: CERTIFICATIONS: # DN24211 Jacas, Jose • Board Certification • Inhalation Sedation # DN4964 Graddy, Nathan NPI: 1669032603 LIC: DN24211 NPI: 1225318025 LIC: DN4964 # FQHC10202 # DN24498 Popek, Barbara NPI: 1740320993 LIC: DN24498 # DN20612 Jean, Darlene # DN19926 Guerra, William Tampa Family Health General Dentist servicing as: Centers, Inc. # DN22607 Rotaru, Ion General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry 1502 E. Fowler Ave General Dentist servicing as: NPI: 1528474822 LIC: DN20612 NPI: 1861749459 LIC: DN19926 Tampa, FL 33612 Pediatric Dentistry # DN23286 tampafamilyhc.com NPI: 1558899658 LIC: DN22607 Joseph, Jobin # DN22578 Healey, Kristyn (813) 397-5300 NPI: 1669883856 LIC: DN23286 NPI: 1619401205 LIC: DN22578 # DN15880 Tibby, Tamara-Kay Special Needs: Yes NPI: 1508893850 LIC: DN15880 # DN18068 Le, Jade # DN23345 Ivanov, Simona English, Spanish CERTIFICATIONS: NPI: 1154541845 LIC: DN18068 NPI: 1861987752 LIC: DN23345 M-T 8am - 5pm • Board Certification CERTIFICATIONS: # DN24211 Jacas, Jose W-F 8am - 5pm • Inhalation Sedation # FQHC10203 NPI: 1669032603 LIC: DN24211 # DN13067 Gamble, Isolda • Conscious Sedation Tampa Family Health # DN17431 Leon, Ana # DN20612 Jean, Darlene NPI: 1992764484 LIC: DN13067 Centers, Inc. General Dentist servicing as: General Dentist servicing as: # DN4964 Graddy, Nathan 3901 S. West Shore Blvd Pediatric Dentistry Pediatric Dentistry NPI: 1225318025 LIC: DN4964 Tampa, FL 33611 NPI: 1578762332 LIC: DN17431 NPI: 1528474822 LIC: DN20612 # DN19926 Guerra, William (813) 397-5300 CERTIFICATIONS: # DN23286 Joseph, Jobin General Dentist servicing as: Special Needs: Yes • Inhalation Sedation NPI LIC: : 1669883856 DN23286 Pediatric Dentistry English, Spanish # DN23805 Najafi, Gina NPI: 1861749459 LIC: DN19926 # DN18068 Le, Jade M-T 8am - 5pm NPI: 1699259291 LIC: DN23805 NPI LIC: # DN23345 Ivanov, Simona W-F 8am - 5pm : 1154541845 DN18068 # DN24498 Popek, Barbara CERTIFICATIONS: NPI: 1861987752 LIC: DN23345 # DN25579FL Azer, Peter NPI: 1740320993 LIC: DN24498 • Inhalation Sedation # DN24211 Jacas, Jose NPI: 1396240875 LIC: DN25579FL • Conscious Sedation NPI: 1669032603 LIC: DN24211 # DN25247 Brown, Jordan # FQHC10204 # DN17431 Leon, Ana NPI: 1982221339 LIC: DN25247 Tampa Family Health General Dentist servicing as: # DN20612 Jean, Darlene Centers, Inc. Pediatric Dentistry # DN22253 Carter, Jade

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 24 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

8108 N. Nebraska Ave General Dentist servicing as: # DN23345 Ivanov, Simona English, Spanish Tampa, FL 33604 Pediatric Dentistry M-T 8am - 5pm NPI: 1861987752 LIC: DN23345 (813) 397-5300 NPI: 1578762332 LIC: DN17431 W-F 8am - 5pm Special Needs: Yes CERTIFICATIONS: # DN24211 Jacas, Jose # DN20880 Brachowicz, Maria English, Spanish • Inhalation Sedation NPI: 1669032603 LIC: DN24211 NPI: 1770992117 LIC: DN20880 M-T 8am - 5pm # DN23805 Najafi, Gina # DN20612 Jean, Darlene # DN20318 Cisneros, Aura W-F 8am - 5pm NPI: 1699259291 LIC: DN23805 General Dentist servicing as: Pediatric Dentistry NPI: 1356346340 LIC: DN20318 # DN25579FL Azer, Peter # DN24498 Popek, Barbara CERTIFICATIONS: NPI: 1396240875 LIC: DN25579FL NPI: 1528474822 LIC: DN20612 NPI: 1740320993 LIC: DN24498 • Inhalation Sedation # DN23286 Joseph, Jobin # DN25247 Brown, Jordan # DN15880 Tibby, Tamara-Kay # DN22362 Colonneaux, Amanda NPI: 1669883856 LIC: DN23286 NPI: 1982221339 LIC: DN25247 NPI: 1508893850 LIC: DN15880 NPI: 1073967519 LIC: DN22362 CERTIFICATIONS: # DN18068 Le, Jade # DN22253 Carter, Jade # DN15132 Dietz, Rodney • Board Certification NPI: 1154541845 LIC: DN18068 NPI: 1487968467 LIC: DN22253 NPI: 1629326277 LIC: DN15132 CERTIFICATIONS: # DN13067 Gamble, Isolda # FQHC10205 • Inhalation Sedation # DN22779 Ordonez, Margaret NPI: 1992764484 LIC: DN13067 Tampa Family Health • Conscious Sedation General Dentist servicing as: # DN4964 Graddy, Nathan Centers, Inc. # DN17431 Leon, Ana Pediatric Dentistry NPI: 1972032795 LIC: DN22779 NPI: 1225318025 LIC: DN4964 7608 Causeway Blvd General Dentist servicing as: Tampa, FL 33619 Pediatric Dentistry # HAD70 Simeoni, Anna # DN19926 Guerra, William tampafamilyhc.com NPI: 1578762332 LIC: DN17431 General Dentist servicing as: NPI: 1396817797 LIC: HAD70 (813) 397-5300 CERTIFICATIONS: Pediatric Dentistry Special Needs: Yes • Inhalation Sedation ORAL SURGEON NPI: 1861749459 LIC: DN19926 English, Spanish # DN23805 Najafi, Gina # DN22578 Healey, Kristyn M-T 8am - 5pm NPI: 1699259291 LIC: DN23805 # 020259 NPI: 1619401205 LIC: DN22578 W-F 8am - 5pm # DN24498 Popek, Barbara Dr. Robert Orta D.D.S., P.A # DN23345 Ivanov, Simona # DN25579FL Azer, Peter NPI: 1740320993 LIC: DN24498 801 W. Dr. Martin Luther Kingjr. NPI: 1861987752 LIC: DN23345 NPI: 1396240875 LIC: DN25579FL Blvd. # DN22607 Rotaru, Ion # DN24211 Jacas, Jose Tampa, FL 33603 # DN25247 Brown, Jordan General Dentist servicing as: ortaoralsugery.com NPI: 1669032603 LIC: DN24211 NPI: 1982221339 LIC: DN25247 Pediatric Dentistry (813) 238-0411 # DN20612 Jean, Darlene NPI: 1558899658 LIC: DN22607 # DN22253 Carter, Jade Special Needs: Yes General Dentist servicing as: NPI: 1487968467 LIC: DN22253 # DN15880 Tibby, Tamara-Kay English, Spanish Pediatric Dentistry # DN13067 Gamble, Isolda NPI: 1508893850 LIC: DN15880 M-T 8am - 5pm NPI: 1528474822 LIC: DN20612 NPI: 1992764484 LIC: DN13067 CERTIFICATIONS: W-Th 8am - 5pm # DN23286 Joseph, Jobin • Board Certification DN14351 # DN4964 Graddy, Nathan # Orta, Robert NPI: 1669883856 LIC: DN23286 NPI: 1225318025 LIC: DN4964 # FQHC010833 NPI: 1376681791 LIC: DN14351 # DN18068 Le, Jade CERTIFICATIONS: # DN19926 Guerra, William Tom Lee Community Health NPI: 1154541845 LIC: DN18068 • Inhalation Sedation General Dentist servicing as: Center CERTIFICATIONS: Pediatric Dentistry 14254 Martin Luther King Blvd # 009954 • Inhalation Sedation S.R. 574 • Conscious Sedation NPI: 1861749459 LIC: DN19926 Tampa Bay Institute of Oral Dover, FL 33527 # DN17431 # DN22578 Healey, Kristyn Surgery & Dental Implants Leon, Ana (813) 349-7736 7720 W. Waters Ave NPI: 1619401205 LIC: DN22578 Special Needs: No

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 25 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Tampa, FL 33615 W 7:30 am - 7pm, Th 7:30 am - W-F 8am - 5pm # DN23280 Polanco, Alejandra* https://.tampabayos.com 8pm, F 7:30 am - 9pm # DN11575 Chin, Leo NPI: 1487181541 LIC: DN23280 (813) 885-6555 # DN11575 Chin, Leo* NPI: 1174731657 LIC: DN11575 CERTIFICATIONS: Special Needs: Yes NPI: 1174731657 LIC: DN11575 CERTIFICATIONS: • Inhalation Sedation English, Arabic, Polish, Spanish CERTIFICATIONS: • Board Certification # DN23997FL Purcell, Kaitlyn* M-T 7:30 am - 4:30 pm • Board Certification # DN10847 Turke, Eric NPI: 1639368145 LIC: DN23997FL W-F 7:30 am - 4:30 pm # DN10847 Turke, Eric* NPI: 1164633483 LIC: DN10847 # DN19235 Rajani, Anjali* # DN18163FL Aves, Renato NPI: 1164633483 LIC: DN10847 NPI: 1104955897 LIC: DN19235 NPI: 1336322650 LIC: DN18163FL PEDIATRIC DENTISTRY CERTIFICATIONS: CERTIFICATIONS: # FQHC010829 • Inhalation Sedation • Inhalation Sedation Ruskin Health Center # 020192-HOSP1 • General Anesthesia # DN18959 Robison, Tamara* 2814 14Th Ave Se Florida Dental Team LLC (By NPI: 1699703355 LIC: DN18959 # DN19301 Caribas-Mendible, Ruskin, FL 33570 Referral Only) CERTIFICATIONS: Alejandro (813) 653-6100 10909 West Linebaugh Ave, Ste • Pediatric Conscious Sedation NPI: 1013204122 LIC: DN19301 Special Needs: Yes 102 • Inhalation Sedation CERTIFICATIONS: English, Spanish Tampa, FL 33626 • Board Certification • Inhalation Sedation M-T 7:30 am - 5pm (813) 774-6003 # DN20019 Tabares, Yadnay* • General Anesthesia W-F 7:30 am - 5pm Special Needs: Yes General Dentist servicing as: # DN23977 Elmohd, Tarik English, Spanish # DN10847 Turke, Eric* Endodontics NPI: 1538556329 LIC: DN23977 NPI: 1164633483 LIC: DN10847 # DN17078 Aliotti, Michelle* NPI: 1669602876 LIC: DN20019 # DN21438 Kalsow, Oleg NPI: 1124142062 LIC: DN17078 CERTIFICATIONS: # FQHC010830 NPI: 1275951972 LIC: DN21438 # DN18989 Chuong, Christopher* • Pediatric Conscious Sedation • Inhalation Sedation # DN19378 Samaniego, Juan Suncoast Mobile Dental Van General Dentist servicing as: • Conscious Sedation NPI: 1467692129 LIC: DN19378 2814 14Th Ave Se Endodontics # DN21646 Theogene, Dorothy* CERTIFICATIONS: Ruskin, FL 33570 NPI: 1992017156 LIC: DN18989 NPI: 1699055004 LIC: DN21646 • Inhalation Sedation (813) 653-6100 CERTIFICATIONS: • General Anesthesia Special Needs: No • Pediatric Conscious Sedation CERTIFICATIONS: • Inhalation Sedation • Inhalation Sedation # DN16473 Walcott, Sean English • Conscious Sedation M-T 8am - 5pm • Board Certification NPI: 1841250743 LIC: DN16473 • Board Certification W-F 8am - 5pm # DN24580 Greene, Stephen* CERTIFICATIONS: # DN25322 Wang, Dixin* NPI: 1194113373 LIC: DN24580 • General Anesthesia # DN10847 Turke, Eric NPI: 1023490026 LIC: DN25322 NPI: 1164633483 LIC: DN10847 # DN18568 Gyles, Richard* ORTHODONTIST # 35024 Weil, Matt* NPI: 1942211180 LIC: DN18568 # FQHC010833 CERTIFICATIONS: NPI: 1710250873 LIC: 35024 # FQHC010832 Tom Lee Community Health • Pediatric Conscious Sedation CERTIFICATIONS: Plant City Family Care Center • Inhalation Sedation • Inhalation Sedation • Board Certification 801 E. Baker Street 14254 Martin Luther King Blvd # DN22269 Willox, Angela* Plant City, FL 33563 S.R. 574 # DN19477 Ojeda Jr., Juan* NPI: 1013120310 LIC: DN22269 (813) 653-6100 Dover, FL 33527 NPI: 1861786949 LIC: DN19477 Special Needs: Yes (813) 349-7736 CERTIFICATIONS: INDIAN RIVER COUNTY English, Spanish Special Needs: No • Inhalation Sedation DENTIST M 7:30 am - 5pm, T 7:30 am - English, Spanish # DN21821FL Patel, Priya* 6pm M-T 8am - 5pm NPI: 1033573662 LIC: DN21821FL

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 26 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN9654 Kronick, Neil CERTIFICATIONS: # DN12337 Knowles, Norman* # 013214 • Conscious Sedation NPI: 1538179528 LIC: DN9654 NPI: 1588766513 LIC: DN12337 Pelican Dental Care, PA # DN9654 Kronick, Neil # 019029133 Marijanovic, CERTIFICATIONS: 2050 40Th Ave, Ste #6 NPI: 1538179528 LIC: DN9654 Christine • Conscious Sedation Vero Beach, FL 32960 NPI: 1538414073 LIC: 019029133 # 019029133 Marijanovic, # DN9654 Kronick, Neil* (772) 569-9781 Christine NPI: 1538179528 LIC: DN9654 Special Needs: No CERTIFICATIONS: • Inhalation Sedation NPI: 1538414073 LIC: 019029133 English, Spanish # 019029133 Marijanovic, CERTIFICATIONS: M-T 8am - 6pm # DN21185 McAndrew, Matthew Christine* • Inhalation Sedation W-F 8am - 6pm NPI: 1194104646 LIC: DN21185 NPI: 1538414073 LIC: 019029133 # DN21185 McAndrew, Matthew CERTIFICATIONS: # DN19163 Perez, Liliana* # DN25590FL Omar, Adil NPI: 1194104646 LIC: DN21185 • Inhalation Sedation NPI: 1831402064 LIC: DN19163 NPI: 1164084927 LIC: DN25590FL # DN25590FL Omar, Adil # DN21185 McAndrew, Matthew* # DN25471FL Starcevic, Mia # FQHC016045 NPI: 1164084927 LIC: DN25590FL NPI: 1194104646 LIC: DN21185 NPI: 1487269189 LIC: DN25471FL Treasure Coast Community # DN25471FL Starcevic, Mia # DN25590FL Omar, Adil* Health, Inc # FQHC7649 NPI: 1487269189 LIC: DN25471FL NPI: 1164084927 LIC: DN25590FL 1955 21St Ave Treasure Coast Community # DN25471FL Starcevic, Mia* Vero Beach, FL 32960 # FQHC7650 Health, Inc NPI: 1487269189 LIC: DN25471FL www.tcchinc.org 12196 County Road, # 512 Treasure Coast Community (772) 257-8224 Fellsmere, FL 32948 Health, Inc JACKSON COUNTY Special Needs: Yes www.tcchinc.org 1545 9Th St Sw English, Spanish (772) 257-8224 Vero Beach, FL 32962 DENTIST M 8am - 6:30 pm, T 8am - 5:30 Special Needs: Yes www.tcchinc.org pm English, Spanish (772) 257-8224 # 020298 W 8am - 5:30 pm, Th 7am - 4:30 M-T 8am - 5:30 pm Special Needs: Yes Larry J. Small DMD Family pm, F 8am - 3:30 pm W 7am - 4:30 pm, Th 8am - 6:30 English, Spanish Dentistry # DN23968 Arana, Raisa pm, F 8am - 3:30 pm M 8am - 5:30 pm, T 7am - 4:30 2822 Highway 71 Ste H NPI: 1386209914 LIC: DN23968 pm # DN23968 Arana, Raisa Marianna, FL 32446 W 8am - 6:30 pm, Th 8am - 5:30 # DN13036 Bongato, Zenaida NPI: 1386209914 LIC: DN23968 (850) 272-9393 pm, F 8am - 3:30 pm NPI: 1922046176 LIC: DN13036 Special Needs: No # DN13036 Bongato, Zenaida # DN23968 Arana, Raisa* English # DN22114 Buchanan, Melanie NPI: 1922046176 LIC: DN13036 NPI: 1386209914 LIC: DN23968 NPI: 1164873428 LIC: DN22114 # DN10981 Small, Larry # DN22114 Buchanan, Melanie # DN13036 Bongato, Zenaida* General Dentist servicing as: # DN16693 Davis, Robert NPI: 1164873428 LIC: DN22114 NPI: 1922046176 LIC: DN13036 Pediatric Dentistry NPI: 1770585275 LIC: DN16693 NPI: 1033133475 LIC: DN10981 # DN16693 Davis, Robert # DN22114 Buchanan, Melanie* # DN22364 Gaponiuk, Mark NPI: 1770585275 LIC: DN16693 NPI: 1164873428 LIC: DN22114 # FQHC016581 NPI: 1003012212 LIC: DN22364 # DN22364 Gaponiuk, Mark # DN16693 Davis, Robert* PanCare of Florida, Inc. # DN8390 Goebel, Gerald NPI: 1003012212 LIC: DN22364 NPI: 1770585275 LIC: DN16693 4126 Independent Dr. NPI: 1245384619 LIC: DN8390 # DN8390 Goebel, Gerald # DN22364 Gaponiuk, Mark* Marianna, FL 32448 # DN12337 Knowles, Norman NPI: 1245384619 LIC: DN8390 NPI: 1003012212 LIC: DN22364 (850) 394-4907 NPI: 1588766513 LIC: DN12337 Special Needs: Yes # DN12337 Knowles, Norman # DN8390 Goebel, Gerald* CERTIFICATIONS: English, Spanish NPI: 1588766513 LIC: DN12337 • Conscious Sedation NPI: 1245384619 LIC: DN8390

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 27 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

M-T 8am - 5pm (850) 569-2053 Ben Saunders DMD Pediatric (352) 314-0888 W-F 8am - 5pm Special Needs: Yes Dentistry Special Needs: Yes # DN10365FL Barry, Steven English, Spanish 4711 Hwy 90 English, Mandarin Chinese M-T 8am - 5pm M-T 8am - 4pm NPI: 1497826531 LIC: DN10365FL Marianna, FL 32446 W-F 8am - 5pm www.allhappyteeth.com # DN8719 Lin, Chun # DN19128 Claussen, Meghann # DN10365FL Barry, Steven (850) 526-7748 NPI: 1568504702 LIC: DN8719 NPI: 1336454651 LIC: DN19128 NPI: 1497826531 LIC: DN10365FL Special Needs: Yes # DN25097 Haynam, Eric English # FQHC022358 # DN25097 Haynam, Eric NPI: 1043688831 LIC: DN25097 M-T 8am - 5pm Community Health Centers, NPI: 1043688831 LIC: DN25097 # DN13094 Hudon, Richard # DN14938 Saunders, Stanley Inc # DN13094 Hudon, Richard NPI: 1245336031 LIC: DN13094 Benjamin* 225 N. 1St Street NPI: 1245336031 LIC: DN13094 NPI: 1932123395 LIC: DN14938 Leesburg, FL 34748 # DN21740 Moffa, Michelle # DN21740 Moffa, Michelle CERTIFICATIONS: www.chcfl.org General Dentist servicing as: General Dentist servicing as: • Pediatric Conscious Sedation (407) 905-8827 NPI: 1841277407 LIC: DN21740 • Inhalation Sedation Special Needs: Yes NPI: 1841277407 LIC: DN21740 # DN19745 Norton, Andrew English, Spanish # DN19745 Norton, Andrew LAKE COUNTY NPI: 1861754020 LIC: DN19745 M 8am - 5pm, T 8am - 7pm NPI: 1861754020 LIC: DN19745 W-Th 8am - 5pm # DN18871 Pate, Sheena DENTIST # DN18871 Pate, Sheena General Dentist servicing as: # DN12870 Browning, Lisa General Dentist servicing as: Pediatric Dentistry # 015274 General Dentist servicing as: Pediatric Dentistry NPI: 1215255880 LIC: DN18871 Central Florida Dental Care, Pediatric Dentistry NPI: 1215255880 LIC: DN18871 NPI: 1457570103 LIC: DN12870 # DN21660 Piorkowski, Gary LLC # DN21660 Piorkowski, Gary General Dentist servicing as: 2390 W. Old Hwy 441, Ste 2 # DN15276 Chen, May General Dentist servicing as: Mount Dora, FL 32757 NPI: 1609096502 LIC: DN15276 NPI: 1699705434 LIC: DN21660 NPI: 1699705434 LIC: DN21660 (352) 735-5255 # DN16298 Chery, Pascale # DN23084 Santos, Iris Special Needs: No # DN23084 Santos, Iris General Dentist servicing as: NPI: 1487875233 LIC: DN23084 English NPI: 1487875233 LIC: DN23084 Pediatric Dentistry # HAD69 Smith, Amy M-T 9am - 5pm NPI: 1235138439 LIC: DN16298 # HAD69 Smith, Amy NPI: 1831209899 LIC: HAD69 W-F 9am - 5pm NPI: 1831209899 LIC: HAD69 # DN13946 Estrada, Luis # DN14975 Constantin, Serioja # DN18668 Van Dyke, General Dentist servicing as: # DN18668 Van Dyke, Kanyaratana NPI: 1225219819 LIC: DN14975 Pediatric Dentistry Kanyaratana NPI: 1003122656 LIC: DN18668 # DN12237 Figaro, Mark NPI: 1245258565 LIC: DN13946 NPI: 1003122656 LIC: DN18668 # HAD65 Wilhite, Rhonda NPI: 1952516965 LIC: DN12237 CERTIFICATIONS: # HAD65 Wilhite, Rhonda • Inhalation Sedation General Dentist servicing as: # DN13227 Johary, Carlos General Dentist servicing as: # DN19362 Gonzalez, Patricia NPI: 1952496341 LIC: HAD65 NPI: 1336338755 LIC: DN13227 NPI: 1952496341 LIC: HAD65 NPI: 1760633739 LIC: DN19362 # DN22573 Williams, Sean # DN25500FL Santana, Liliana # DN22573 Williams, Sean CERTIFICATIONS: NPI: 1306376512 LIC: DN22573 NPI: 1750998209 LIC: DN25500FL • Inhalation Sedation NPI: 1306376512 LIC: DN22573 # DN21870FL Gordon, Toni-Anne # FQHC932150 # 018925 PEDIATRIC DENTISTRY NPI: 1376077040 LIC: DN21870FL PanCare of Florida, Inc. Chun In Lin # DN8556 Kiernan, Loyd 5336 10Th St # 010953 404 N. Perkins St. NPI: 1578502332 LIC: DN8556 Malone, FL 32445 Leesburg, FL 34748

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 28 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN15208 Mcdowell-Travis, NPI: 1548754849 LIC: DN23384 # DN15208 Mcdowell-Travis, NPI: 1548754849 LIC: DN23384 Janet # DN18247 Wray, Roger Janet # DN18247 Wray, Roger General Dentist servicing as: General Dentist servicing as: General Dentist servicing as: General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry Pediatric Dentistry Pediatric Dentistry NPI: 1992072540 LIC: DN15208 NPI: 1992072540 LIC: DN15208 NPI: 1528026630 LIC: DN18247 NPI: 1528026630 LIC: DN18247 # DN19016 Munguba, Bozena # DN19016 Munguba, Bozena # FQHC014606 # FQHC824204 NPI: 1043530462 LIC: DN19016 NPI: 1043530462 LIC: DN19016 Community Health Centers, Four Corners - Community # DN18690 Nguyen, Kathleen # DN18690 Nguyen, Kathleen Inc. Health Centers, Inc General Dentist servicing as: General Dentist servicing as: 212 E. Main St 509 Cagan View Rd Pediatric Dentistry Pediatric Dentistry Tavares, FL 32778 Clermont, FL 34714 NPI: 1013143544 LIC: DN18690 NPI: 1013143544 LIC: DN18690 www.chcfl.org www.chcfl.org CERTIFICATIONS: CERTIFICATIONS: (407) 905-8827 (407) 905-8827 • Inhalation Sedation • Inhalation Sedation Special Needs: Yes Special Needs: No # DN11858 Palomeque, Theresa # DN11858 Palomeque, Theresa English, Spanish English, Spanish General Dentist servicing as: General Dentist servicing as: M 8am - 6pm, T 8am - 6:30 pm M 8am - 6pm, T 8am - 7pm Pediatric Dentistry Pediatric Dentistry W-Th 8am - 5pm W-Th 8am - 5pm NPI: 1386618544 LIC: DN11858 NPI: 1386618544 LIC: DN11858 # DN12870 Browning, Lisa # DN12870 Browning, Lisa CERTIFICATIONS: CERTIFICATIONS: • Inhalation Sedation General Dentist servicing as: • Inhalation Sedation General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry # DN12387 Poveromo, Marc # DN12387 Poveromo, Marc NPI: 1457570103 LIC: DN12870 NPI: 1457570103 LIC: DN12870 General Dentist servicing as: General Dentist servicing as: Pediatric Dentistry # DN15276 Chen, May Pediatric Dentistry # DN15276 Chen, May NPI: 1780745141 LIC: DN12387 NPI: 1609096502 LIC: DN15276 NPI: 1780745141 LIC: DN12387 NPI: 1609096502 LIC: DN15276 CERTIFICATIONS: CERTIFICATIONS: # DN16298 Chery, Pascale # DN16298 Chery, Pascale • Inhalation Sedation • Inhalation Sedation General Dentist servicing as: General Dentist servicing as: # DN22449 # DN22449 Stewart, Elizabeth Pediatric Dentistry Stewart, Elizabeth Pediatric Dentistry General Dentist servicing as: NPI: 1235138439 LIC: DN16298 General Dentist servicing as: NPI: 1235138439 LIC: DN16298 Pediatric Dentistry Pediatric Dentistry # DN13946 Estrada, Luis # DN13946 Estrada, Luis NPI: 1891155271 LIC: DN22449 NPI: 1891155271 LIC: DN22449 General Dentist servicing as: General Dentist servicing as: # DN10172 # DN10172 Stewart, Gregg Pediatric Dentistry Stewart, Gregg Pediatric Dentistry General Dentist servicing as: NPI: 1245258565 LIC: DN13946 General Dentist servicing as: NPI: 1245258565 LIC: DN13946 Pediatric Dentistry Pediatric Dentistry CERTIFICATIONS: CERTIFICATIONS: NPI: 1619977733 LIC: DN10172 NPI: 1619977733 LIC: DN10172 • Inhalation Sedation • Inhalation Sedation # DN16458 Teodoru, Catalin # DN19362 Gonzalez, Patricia # DN16458 Teodoru, Catalin # DN19362 Gonzalez, Patricia General Dentist servicing as: NPI: 1760633739 LIC: DN19362 General Dentist servicing as: NPI: 1760633739 LIC: DN19362 Pediatric Dentistry Pediatric Dentistry CERTIFICATIONS: CERTIFICATIONS: NPI: 1407854847 LIC: DN16458 NPI: 1407854847 LIC: DN16458 • Inhalation Sedation • Inhalation Sedation # DN13300 Velez-Leon, Waleska # DN21870FL Gordon, Toni-Anne # DN13300 Velez-Leon, Waleska # DN21870FL Gordon, Toni-Anne General Dentist servicing as: NPI: 1376077040 LIC: DN21870FL General Dentist servicing as: NPI: 1376077040 LIC: DN21870FL Pediatric Dentistry Pediatric Dentistry # DN8556 Kiernan, Loyd # DN8556 Kiernan, Loyd NPI: 1316040819 LIC: DN13300 NPI: 1316040819 LIC: DN13300 NPI: 1578502332 LIC: DN8556 NPI: 1578502332 LIC: DN8556 # DN23384 Vo, Tina # DN23384 Vo, Tina

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 29 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN15208 Mcdowell-Travis, General Dentist servicing as: NPI: 1235138439 LIC: DN16298 CERTIFICATIONS: Pediatric Dentistry • Inhalation Sedation Janet # DN13946 Estrada, Luis General Dentist servicing as: NPI: 1316040819 LIC: DN13300 # DN22449 Stewart, Elizabeth General Dentist servicing as: Pediatric Dentistry # DN23384 Vo, Tina Pediatric Dentistry General Dentist servicing as: NPI: 1992072540 LIC: DN15208 NPI: 1548754849 LIC: DN23384 NPI: 1245258565 LIC: DN13946 Pediatric Dentistry # DN19016 Munguba, Bozena NPI: 1891155271 LIC: DN22449 # DN18247 Wray, Roger CERTIFICATIONS: • Inhalation Sedation # DN10172 Stewart, Gregg NPI: 1043530462 LIC: DN19016 General Dentist servicing as: General Dentist servicing as: # DN18690 Nguyen, Kathleen Pediatric Dentistry # DN19362 Gonzalez, Patricia Pediatric Dentistry General Dentist servicing as: NPI: 1528026630 LIC: DN18247 NPI: 1760633739 LIC: DN19362 NPI: 1619977733 LIC: DN10172 Pediatric Dentistry CERTIFICATIONS: NPI: 1013143544 LIC: DN18690 # 016498 • Inhalation Sedation # DN16458 Teodoru, Catalin CERTIFICATIONS: Jeff Molloy DDS PA # DN21870FL Gordon, Toni-Anne General Dentist servicing as: • Inhalation Sedation 820 W Montrose Street NPI: 1376077040 LIC: DN21870FL Pediatric Dentistry # DN15582 Nicola, Rania Clermont, FL 34711 NPI: 1407854847 LIC: DN16458 # DN8556 Kiernan, Loyd General Dentist servicing as: (352) 394-4567 # DN13300 Velez-Leon, Waleska NPI: 1578502332 LIC: DN8556 Pediatric Dentistry Special Needs: No General Dentist servicing as: NPI: 1033186986 LIC: DN15582 English # DN15208 Mcdowell-Travis, Pediatric Dentistry Janet # DN11858 Palomeque, Theresa M-T 8:30 am - 5pm NPI: 1316040819 LIC: DN13300 W-Th 8:30 am - 5pm General Dentist servicing as: General Dentist servicing as: # DN23384 Vo, Tina* Pediatric Dentistry Pediatric Dentistry # DN21435 Molloy, Jeffrey* NPI: 1992072540 LIC: DN15208 NPI: 1548754849 LIC: DN23384 NPI: 1386618544 LIC: DN11858 NPI: 1821209990 LIC: DN21435 # DN19016 # DN18247 Wray, Roger CERTIFICATIONS: Munguba, Bozena General Dentist servicing as: • Inhalation Sedation # FQHC7969 NPI: 1043530462 LIC: DN19016 Pediatric Dentistry # DN12387 Poveromo, Marc # DN18690 South Lake Dental Nguyen, Kathleen NPI: 1528026630 LIC: DN18247 General Dentist servicing as: (Community Health Ctr) General Dentist servicing as: Pediatric Dentistry 1296 W. Broad Street Pediatric Dentistry LEE COUNTY NPI: 1780745141 LIC: DN12387 Groveland, FL 34736 NPI: 1013143544 LIC: DN18690 CERTIFICATIONS: www.chcfl.org CERTIFICATIONS: DENTIST • Inhalation Sedation (407) 905-8827 • Inhalation Sedation # DN22449 Stewart, Elizabeth Special Needs: Yes # DN15582 Nicola, Rania* # 011545 General Dentist servicing as: Spanish General Dentist servicing as: Edison Mall Dental PA Pediatric Dentistry M 8am - 6pm, T 8am - 6:30 pm Pediatric Dentistry 4125 Cleveland Ave Ste 1430 NPI: 1891155271 LIC: DN22449 W-Th 8am - 5pm NPI: 1033186986 LIC: DN15582 Fort Myers, FL 33901 # DN10172 Stewart, Gregg # DN12870 Browning, Lisa # DN11858 Palomeque, Theresa (239) 939-9050 General Dentist servicing as: General Dentist servicing as: General Dentist servicing as: Special Needs: Yes Pediatric Dentistry Pediatric Dentistry Pediatric Dentistry English, Russian, Spanish NPI: 1619977733 LIC: DN10172 NPI: 1457570103 LIC: DN12870 NPI: 1386618544 LIC: DN11858 M-T 11am - 8pm

# DN16458 Teodoru, Catalin # DN15276 Chen, May CERTIFICATIONS: W-F 11am - 8pm • Inhalation Sedation General Dentist servicing as: NPI: 1609096502 LIC: DN15276 # DN25272 Alameri, Mustafa* Pediatric Dentistry # DN12387 Poveromo, Marc NPI: 1912516626 LIC: DN25272 # DN16298 Chery, Pascale NPI: 1407854847 LIC: DN16458 General Dentist servicing as: General Dentist servicing as: # DN22246 Antezana, Mauricio* Pediatric Dentistry # DN13300 Velez-Leon, Waleska Pediatric Dentistry General Dentist servicing as: NPI: 1780745141 LIC: DN12387 Pediatric 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 30 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1063876399 LIC: DN22246 # DN20101 Licina, Zeljka* # DN23633 Andrade, Emily* # 022536 # DN21079 Arnedo, Johanna* NPI: 1013263292 LIC: DN20101 NPI: 1407335409 LIC: DN23633 Lee Bella Dental General Dentist servicing as: # DN24055 Lodhi, Hafsa* # DN20845 Bradley, Alijah* Pediatric Dentistry 6844 International Center Blvd, NPI: 1588023584 LIC: DN24055 NPI: 1003224148 LIC: DN20845 NPI: 1104213909 LIC: DN21079 Ste A # DN19470 Maniglia, Marielba* CERTIFICATIONS: # DN10457FL Broggi, Edward* Fort Myers, FL 33912 • Inhalation Sedation NPI: 1063793644 LIC: DN19470 NPI: 1215955190 LIC: DN10457FL (239) 691-8380 Special Needs: Yes # DN17412 Atkinson, William* # 24529 Moini, Marshall* # DN24614 Cerrutti, Juan* English, Spanish General Dentist servicing as: NPI: 1437700937 LIC: 24529 NPI: 1992233167 LIC: DN24614 M-T 9am - 4pm Pediatric Dentistry # DN23402 Montenegro, # DN17996FL Etemadshahidi, W-F 9am - 4pm NPI: 1942360862 LIC: DN17412 Christian* Babak* CERTIFICATIONS: # DN21607 Velasquez-Pierce, NPI: 1144714445 LIC: DN23402 NPI: 1336300805 LIC: DN17996FL • Inhalation Sedation Ximena # DN23652 Ospina, Luz* # DN17123 Bravo, Raquel* # DN24425 Faizzadeh, Paula* NPI: 1548606874 LIC: DN21607 General Dentist servicing as: NPI: 1538312525 LIC: DN17123 NPI: 1912550799 LIC: DN24425 Oral Surgery # 007731 # DN21812 Cabrera, Rene* # DN25050 Gross, Steven* NPI: 1881181501 LIC: DN23652 Rapident General Dentist servicing as: NPI: 1063029122 LIC: DN25050 # DN23021 Riboul, Sandrine* 3722 Central Ave, Ste #1 Pediatric Dentistry # DN7364 Josephson, Gerald* NPI: 1609227057 LIC: DN23021 NPI: 1518313675 LIC: DN21812 Ft Myers, FL 33901 CERTIFICATIONS: NPI: 1184684615 LIC: DN7364 (239) 274-7687 # DN24313FL Evans, Mana* • Inhalation Sedation # DN23511 Nguyen, Chi* Special Needs: Yes NPI: 1750818712 LIC: DN24313FL # DN23007 Rivera, Lina* NPI: 1811482656 LIC: DN23511 English, Spanish # DN22714 Fornes-Ferrero, NPI: 1760908743 LIC: DN23007 CERTIFICATIONS: M-T 10am - 5pm Patricia* • Inhalation Sedation # DN20475 Santiago, Germaine* # DN13261 Putzeys, Rodolfo* General Dentist servicing as: # DN23454FL Nguyen, Michelle* NPI 1922341460 LIC: DN20475 NPI: 1578697553 LIC: DN13261 Pediatric Dentistry : General Dentist servicing as: # DN21066 NPI: 1619407566 LIC: DN22714 Uzunova-Dimova, Endodontics PERIODONTICS # DN20710 Gonzalez, Kely* Kalina* NPI: 1033603733 LIC: DN23454FL General Dentist servicing as: NPI: 1952717027 LIC: DN20710 CERTIFICATIONS: # 011545 Pediatric Dentistry • Inhalation Sedation Edison Mall Dental PA # DN17335FL Guilarte, Rhona* NPI: 1245540947 LIC: DN21066 # DN13556 Schreiber, Page* NPI: 1619956323 LIC: DN17335FL 4125 Cleveland Ave Ste 1430 # 021857 General Dentist servicing as: Fort Myers, FL 33901 # DN23847 Khan, Adiba* Endodontics Happy Smiles of Fort Myers (239) 939-9050 NPI: 1649638172 LIC: DN23847 NPI: 1023280807 LIC: DN13556 Special Needs: Yes 2675 Winkler Ave, Unit 150 # DN22197 Khatib, Adel* # DN24429FL Shahriari, English, Russian, Spanish Fort Myers, FL 33901 General Dentist servicing as: Varahram* M-T 11am - 8pm happysmilesfortmyers.com Endodontics General Dentist servicing as: W-F 11am - 8pm (239) 204-2780 NPI: 1235582503 LIC: DN22197 Endodontics Special Needs: Yes # DN13591 Nielsen, Pamela* NPI: 1952954778 LIC: DN24429FL # DN16377 Krasnov, Rostislav* English, Russian, Spanish NPI: 1124118245 LIC: DN13591 NPI: 1942267935 LIC: DN16377 M-T 9am - 5pm # DN16481 Zadov, Marianna* LEON COUNTY # DN24131 Krupnov, Vera* W-F 9am - 5pm NPI: 1104903301 LIC: DN16481 CERTIFICATIONS: NPI: 1386202984 LIC: DN24131 # DN23676 Aldaya, Robair* DENTIST • Inhalation Sedation NPI: 1508344599 LIC: DN23676

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 31 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

DOH - Leon County Health (850) 577-0435 # EV1038362 # EV517957 Department Special Needs: Yes AA Prime Care Dental 912 Railroad Ave English, Spanish, Swahili Lawrence J Pijut, DMD, PA Associates Tallahassee, FL 32310 M-T 7:30 am - 6:30 pm 2560 Capital Medical Blvd 3514 C/D Mahan Dr (850) 404-6450 W-F 7:30 am - 6:30 pm Tallahassee, FL 32308 Tallahassee, FL 32308 Special Needs: No # HAD84 Hall, Shai (850) 216-2500 (850) 208-3654 English, Chinese Mandarin, NPI: 1013043637 LIC: HAD84 Special Needs: Yes Special Needs: Yes Spanish English # DN21433 Iduate Banobre, English, Spanish, French, Haitian; M-T 8am - 5pm M 8:30 am - 5pm, T 8am - 5pm Yolanda Haitian Creole, Romanian W-F 8am - 5pm W-F 8am - 5pm W-F 9am - 5pm NPI: 1598140618 LIC: DN21433 # DN21218 Baptiste, Ashley # DN0013681FL Pijut, Lawrence # DN14991 Alniti, Daniel # DN20236 Laing, Christopher NPI: 1548642887 LIC: DN21218 NPI: 1235382813 LIC: DN0013681FL General Dentist servicing as: General Dentist servicing as: # DN10711 Bidwell, John CERTIFICATIONS: Pediatric Dentistry Pediatric Dentistry • Inhalation Sedation NPI: 1699978809 LIC: DN14991 General Dentist servicing as: NPI: 1356696272 LIC: DN20236 NPI: 1174553689 LIC: DN10711 # DN7301 McCabe, John # DN18939 Thiry, Warren # EV918894 CERTIFICATIONS: General Dentist servicing as: NPI: 1477871697 LIC: DN18939 Tallahassee Oral And • Inhalation Sedation Pediatric Dentistry Maxillofacial Surgery # DN11663 Bridges, Catherine NPI: 1588734149 LIC: DN7301 # FQHC018638 3665 Coolidge Ct Ste 102 NPI: 1659309821 LIC: DN11663 Neighborhood Medical Tallahassee, FL 32311 # FQHC010635 # DN16771 Liu, Jiguo Center Inc. tallahasseeoms.com Bond Community Health General Dentist servicing as: 3013 Jim Lee Road (850) 431-6725 Center, Inc. Special Needs: Yes NPI: 1629036298 LIC: DN16771 Tallahassee, FL 32301 1720 S. Gadsden St, Ste 219 English, Spanish CERTIFICATIONS: www.neighborhoodmedicalcente Tallahassee, FL 32301 • Inhalation Sedation r.org M-T 8am - 5pm (850) 521-5121 • Conscious Sedation (850) 391-5109 W-F 8am - 5pm Special Needs: Yes Special Needs: Yes # DN21150 Rugmini Pillai, # DN23064 Ortiz, Ricardo English, Spanish English, Spanish Prathibha NPI: 1497984785 LIC: DN23064 M-T 8am - 6pm M-T 7:30 am - 6:30 pm General Dentist servicing as: W-Th 8am - 6pm W-F 7:30 am - 6:30 pm MANATEE COUNTY NPI: 1639466006 LIC: DN21150 # DN18255 Lopez-Rivera, Marcial # HAD84 Hall, Shai CERTIFICATIONS: DENTIST NPI: 1497728117 LIC: DN18255 • Inhalation Sedation NPI: 1013043637 LIC: HAD84 # DN9380 Manocha, Ashok # DN11385 Traul Jr., Robert # DN21433 Iduate Banobre, # 011168 General Dentist servicing as: General Dentist servicing as: Yolanda LeCom School of Dental Pediatric Dentistry Pediatric Dentistry NPI: 1598140618 LIC: DN21433 NPI: 1467669606 LIC: DN9380 NPI: 1982734257 LIC: DN11385 Medicine # DN20236 Laing, Christopher 4800 Lakewood Ranch Blvd # DN7339 Tolley, Leonard General Dentist servicing as: # FQHC014446 Bradenton, FL 34211 General Dentist servicing as: Pediatric Dentistry (941) 405-1600 Pediatric Dentistry Neighborhood Medical NPI: 1356696272 LIC: DN20236 Special Needs: Yes NPI: 1902822497 LIC: DN7339 Center Inc. # DN18939 Thiry, Warren English, Arabic, Russian, Spanish 872 W.Orange Ave M-T 8:30 am - 4:30 pm # CHC10236 Tallahassee, FL 32310 NPI: 1477871697 LIC: DN18939 W-F 8:30 am - 4:30 pm www.neighborhoodmedicalcente ORAL SURGEON r.org # DN12523 Lipton, Barry

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 32 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1689676918 LIC: DN12523 # DN24605 Potts-Williams, NPI: 1356493704 LIC: HAD105 # 020059 # DN19387 Manibo, Lourdes Madge # DN16796 Nguyen, Phuc-Hau NPI: 1902028780 LIC: DN24605 Montiel Dental Care PA Alexandra NPI: 1831303759 LIC: DN16796 NPI: 1730312760 LIC: DN19387 # DN19389 Sanchez, Arnaldo 6818 14Th St W # DN21699 Spenn, Jonathan Bradenton, FL 34207 # DN8944 Ottenga, Marc NPI: 1831486844 LIC: DN19389 (941) 782-8058 NPI: 1942435318 LIC: DN21699 NPI: 1306802293 LIC: DN8944 Special Needs: No # FQHC015356 # FQHC011141 CERTIFICATIONS: English, Spanish • Inhalation Sedation Manatee Village Dental Heart of Florida Health Center # DN23640 Moreno Montiel, Yuliet # DTP651 Supczenski, John Center 1312 Manatee Ave East General Dentist servicing as: NPI: 1538159934 LIC: DTP651 1025 Sw 1St Ave Bradenton, FL 34208 Endodontics Ocala, FL 34471 (941) 708-8710 NPI: 1841786647 LIC: DN23640 # M013843 (352) 732-6599 Special Needs: Yes Manatee County Rural # 011207 Special Needs: Yes English, Spanish Health Serv, - Health English, Spanish M-T 8am - 5pm Ward Family Dental, PA M-T 8am - 5pm Express (Mobile) W-F 8am - 5pm 1619 Tallevast Road W-F 8am - 5pm 12271 Us Hwy 301 N Tallevast, FL 34270 # DN5615 Acquaro, Ronald # DN18780 Dietz, Cristen Parrish, FL 34219 (941) 355-4800 NPI: 1558409169 LIC: DN5615 mcr.health Special Needs: Yes NPI: 1558590851 LIC: DN18780 (941) 776-4000 CERTIFICATIONS: English, Spanish, French # DN15057 Greenwald, Lara Special Needs: Yes • Pediatric Conscious Sedation M-T 4pm - 6pm NPI: 1417126699 LIC: DN15057 English, Spanish # DN21300 Alonso, Anamevys # DN5019 Ward, Clifford* General Dentist servicing as: # DN24458FL Patel, Niyati # DN21300 Alonso, Anamevys Pediatric Dentistry NPI: 1386856615 LIC: DN5019 NPI: 1043864168 LIC: DN24458FL General Dentist servicing as: NPI: 1669868147 LIC: DN21300 Pediatric Dentistry # DN17405 Ward, Tasha* # FQHC013562 NPI: 1669868147 LIC: DN21300 # DN12476FL Bridge, Donna NPI: 1528087871 LIC: DN17405 Heart of Florida Health # DN12476FL Bridge, Donna NPI: 1497967608 LIC: DN12476FL MARION COUNTY Center Inc NPI: 1497967608 LIC: DN12476FL # DN19659 Cherry, Jerry 2553 E. Silver Springs Blvd General Dentist servicing as: DENTIST # DN19659 Cherry, Jerry Ocala, FL 34470 Pediatric Dentistry General Dentist servicing as: www.myhfhc.org NPI: 1700172129 LIC: DN19659 Pediatric Dentistry # CHC10191 (352) 732-6599 NPI: 1700172129 LIC: DN19659 # DN18543 Keo, Phanith DOH - Marion County Health Special Needs: Yes General Dentist servicing as: # DN18543 Keo, Phanith Department Spanish, English Pediatric Dentistry General Dentist servicing as: 1501 W Silver Springs Blvd M-T 8am - 5pm NPI: 1285828491 LIC: DN18543 Pediatric Dentistry Ocala, FL 34475 W-F 8am - 5pm (352) 622-2664 NPI: 1285828491 LIC: DN18543 # DN14205 Melean, Alfonso # DN18780 Dietz, Cristen Special Needs: Yes # DN13120 Martinez, Susana NPI: 1609845031 LIC: DN14205 NPI: 1558590851 LIC: DN18780 Spanish, English General Dentist servicing as: # DN24605 Potts-Williams, M-T 8am - 5pm # DN15057 Greenwald, Lara Pediatric Dentistry Madge W-F 8am - 5pm NPI: 1417126699 LIC: DN15057 NPI: 1215015144 LIC: DN13120 NPI: 1902028780 LIC: DN24605 # DN11663 Bridges, Catherine # DN24458FL Patel, Niyati # DN14205 Melean, Alfonso # DN19389 Sanchez, Arnaldo NPI: 1659309821 LIC: DN11663 NPI: 1043864168 LIC: DN24458FL NPI: 1609845031 LIC: DN14205 NPI: 1831486844 LIC: DN19389 # HAD105 King, Mary Lynn

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 33 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Special Needs: Yes Ace Smiles Dental # FQHC10256 ORAL SURGEON English, Spanish Associates Langley Health Services M 8am - 6pm, T 8am - 5pm 14138 Sw 8Th St Ste #1 # 021810 7205 Se Maricamp Rd W-Th 8am - 5pm Miami, FL 33184 Center for Specialized Ocala, FL 34472 # DN20720 Blackwood, Alberto (786) 717-7779 Dentistry (By Referral Only) (352) 680-7011 NPI: 1487057303 LIC: DN20720 Special Needs: Yes Special Needs: Yes 2830 Se Federal Highway English, Spanish, Default to 0, # DN13607 Morales, Carlos English, Spanish Stuart, FL 34994 French M-T 8am - 5pm NPI: 1457310559 LIC: DN13607 (772) 219-2224 M-T 9am - 5pm W-F 8am - 5pm # DN14000 Naryshkin, George Special Needs: Yes W-F 9am - 5pm English, Spanish # DN19878 Clinton, Edna NPI: 1730395773 LIC: DN14000 # DN18576 Mendoza, Irenia General Dentist servicing as: # DN23400 Pham, Emily # DN15453 Most, Douglas* NPI: 1124256920 LIC: DN18576 Pediatric Dentistry NPI: 1851947568 LIC: DN23400 NPI: 1093835217 LIC: DN15453 CERTIFICATIONS: NPI: 1376853929 LIC: DN19878 • Inhalation Sedation # DN13771 Sanchez, Armando CERTIFICATIONS: MIAMI-DADE COUNTY • Inhalation Sedation NPI: 1992764930 LIC: DN13771 # 021748 DENTIST # DN24579FL Johnson, Christina # DN13207 Zayas, Alida Acuario Dental Group NPI: 1578104063 LIC: DN24579FL NPI: 1639148968 LIC: DN13207 4355 W. 16 Ave, Ste 205A # EV765077 Hialeah, FL 33012 # DN21667 Pirie, Edward # FQHC020248 A+ Dental of Aventura (786) 800-9507 NPI: 1255705752 LIC: DN21667 Florida Community Health 2925 Aventura Blvd Ste 309 Special Needs: Yes # DN15250 Vavruska, Julie Centers, Inc. Miami, FL 33180 English, Spanish General Dentist servicing as: 3441 Se Willoughby Blvd (305) 935-4800 M 9am - 6pm, T 2am - 6pm Pediatric Dentistry Special Needs: Yes Stuart, FL 34994 # DN14821 Ayala, Rita NPI: 1992798649 LIC: DN15250 English, Spanish (772) 403-5650 NPI: 1619090289 LIC: DN14821 CERTIFICATIONS: Special Needs: Yes M-T 9am - 6pm • Inhalation Sedation English, Spanish, Creoles and Th-F 9am - 6pm # 013231 # DN14803 Worthy, Michele Pidgins English-based(other) # DN21257 Perez, Anny Adolfo E. Mares Dental Office General Dentist servicing as: M 8am - 6pm, T 8am - 5pm NPI: 1144602400 LIC: DN21257 306 Sw 12Ave, Ste B Pediatric Dentistry W-Th 8am - 5pm Miami, FL 33130 NPI 1023196169 LIC: DN14803 : # DN20720 Blackwood, Alberto # 007543 (305) 642-0535 CERTIFICATIONS: NPI: 1487057303 LIC: DN20720 AB Dentistry Inc Special Needs: No • Inhalation Sedation # DN13607 Morales, Carlos 9840 Sw 40Th St English, Spanish MARTIN COUNTY NPI: 1457310559 LIC: DN13607 Miami, FL 33165 M-T 10am - 5pm (305) 223-0420 W-F 10am - 5pm # DN14000 Naryshkin, George DENTIST Special Needs: Yes # DN12527 Mares, Adolfo NPI: 1730395773 LIC: DN14000 English, Spanish NPI: 1811048937 LIC: DN12527 # FQHC020246 # DN23400 Pham, Emily M 9am - 6pm, T 9am - 1pm

Florida Community Health NPI: 1851947568 LIC: DN23400 # DN16665 Betancourt, Arely # 009021 Centers, Inc. # DN13771 Sanchez, Armando NPI: 1265528897 LIC: DN16665 Aladino Valiente, DMD, PA 15858 Sw Warfield Blvd NPI: 1992764930 LIC: DN13771 12781 Sw 42Nd Street, Ste D Indiantown, FL 34956 # 013660 Miami, FL 33175 www.fchcinc.org # DN13207 Zayas, Alida www.valientedental.com (772) 597-3596 NPI: 1639148968 LIC: DN13207

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 34 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

(305) 226-7404 1350 Sw 57 Ave Ste 106 Special Needs: Yes # 007563 # 021615 Miami, FL 33144 Spanish, English All Family Care Inc Alpha Dental Group 2 (305) 265-6120 M-T 9am - 6pm 38 Nw 8Th St 5870 Sw 8 Street, Ste 4 Special Needs: No W-F 9am - 6pm Homestead, FL 33030 Miami, FL 33144 English, Spanish # DN15599 Valiente, Aladino (305) 246-0460 (305) 392-1261 M-T 9am - 5pm W-F 9am - 5pm NPI: 1609935626 LIC: DN15599 Special Needs: No Special Needs: Yes English, Spanish, French English, Spanish # DN20182 Aponte-Barrios, Secil # 009529 M 11am - 6pm, T 9am - 5pm M-T 9am - 6pm NPI: 1164714176 LIC: DN20182 Alejandro De La Cruz, D.D.S., # DN12529 Martinez, Jose W-F 9am - 6pm # EV441632 P.A. NPI: 1780798926 LIC: DN12529 # DN14173 Bobadilla, Patricia 7380 Sw 40 St, Ste B AquaBlue Dental # DN14649 Puente, Katia NPI: 1124039672 LIC: DN14173 Miami, FL 33155 11776 Sw 88Th St NPI: 1245357805 LIC: DN14649 (305) 441-2773 # 006690 Miami, FL 33186 Special Needs: Yes # 016126 Amaury Rodriguez, DDS (786) 708-4494 English, Spanish Special Needs: No All In One Dental Services 3944 W. Flagler Street M-T 9am - 6pm Miami, FL 33134 English, Spanish 13728 Sw 84Th Street # DN14560 De la Cruz, Alejandro (305) 445-1405 M-T 9am - 6pm Miami, FL 33183 NPI 1013152016 LIC: DN14560 Special Needs: Yes W-Th 9am - 6pm : www.aiodentist.com Spanish, English # DN20110FL Fernandez, Yeny (305) 456-7383 # 013603 M-T 8:30 am - 5pm Special Needs: Yes NPI: 1861784688 LIC: DN20110FL Alicia B. Cayon, D.M.D., P.A. W-F 8:30 am - 5pm English, Spanish # 021793 8370 W Flagler St Ste 150 M-T 9am - 6pm # DN12779 Rodriguez, Amaury Miami, FL 33144 W-F 9am - 6pm NPI: 1437251568 LIC: DN12779 A-Z Dental Inc (305) 227-3083 # DN14821 Ayala, Rita 5924 West 16Th Ave Special Needs: No # 013162 Hialeah, FL 33012 NPI: 1619090289 LIC: DN14821 English, Spanish America Dental Clinic (305) 558-2133 # DN11609 Herdocia, Filiberto M-T 9am - 5pm 3631 Sw 87Th Ave Special Needs: Yes NPI: 1750788030 LIC: DN11609 W-F 9am - 5pm Miami, FL 33165 English, Spanish # DN20679 Cayon, Alicia # DN17506 Mora, Yosjany (305) 485-8427 M-T 9:30 am - 6pm NPI: 1467865022 LIC: DN20679 NPI: 1922179613 LIC: DN17506 Special Needs: Yes W-F 9:30 am - 6pm English, Spanish # DN14173 Bobadilla, Patricia # 016360 # 012970 M-T 9am - 6pm NPI: 1124039672 LIC: DN14173 All Dental Paradise Alpha Dental Group W-Th 9am - 6pm 15 Sw 107Th Ave 4999 W 8 Ave Ste 1 # DN20289 Soto Menendez, # EV547627 Miami, FL 33174 Hialeah, FL 33012 Lisbet Beautiful Smiles Dental (305) 506-6616 (786) 953-5943 NPI: 1679915953 LIC: DN20289 5376 W 16Th Ave Special Needs: No Special Needs: No # DN17931 Toirac, Maria Hialeah, FL 33012 English, Spanish English, Spanish beautifulsmilesmia.com NPI: 1790987543 LIC: DN17931 M-T 10am - 5pm M-T 9am - 5pm (305) 231-5455 W-F 10am - 5pm W-F 9am - 5pm # 012979 Special Needs: Yes # DN21594 Palacios, Ana # DN14173 Bobadilla, Patricia Aponte Dental Corp English, Spanish NPI: 1295925717 LIC: DN21594 NPI: 1124039672 LIC: DN14173 M-T 9am - 5pm

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 35 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

W-F 9am - 5pm # DN19249 Pria, Carlos General Dentist servicing as: English, Spanish Endodontics # DN18624 Rey, Yanet NPI: 1811166838 LIC: DN19249 M-T 8am - 4:30 pm NPI: 1891074183 LIC: DN19497 W-F 8am - 4:30 pm NPI: 1174751176 LIC: DN18624 CERTIFICATIONS: CERTIFICATIONS: • Inhalation Sedation # DN9529 Alfonso, Rafael • Board Certification • Inhalation Sedation # 012298 NPI: 1669546784 LIC: DN9529 # DN16074 Soheil, Michelle Best Family Dental # 018293 # DN24503 Cole, Eric NPI: 1215014394 LIC: DN16074 5190 Nw 167 St #216 Broward Mall Dental NPI: 1265848881 LIC: DN24503 Miami Gardens, FL 33014 # FQHC017137 1334 Sw 1St St # DN20585 Conde, Yitsy (305) 624-4114 Miami, FL 33135 Special Needs: Yes Borinquen Health Care NPI: 1760737324 LIC: DN20585 (305) 230-4426 Center, Inc. # DN15957 De la Torre, Carmen English, Spanish Special Needs: Yes M-T 9am - 5pm 708 Ne 125Th St English NPI: 1093892150 LIC: DN15957 North Miami, FL 33161 # DN12269 Blay, Marina M-T 11am - 8pm (305) 576-6611 # EV700153 NPI: 1932425972 LIC: DN12269 W-F 11am - 8pm Special Needs: Yes CAN Community Health, Inc # DN22548FL Dopazo Alonso, English, Farsi, French, Spanish # DN24313FL Evans, Mana 427 Washington Ave Dhunia M-T 8am - 5pm NPI: 1750818712 LIC: DN24313FL Miami Beach, FL 33139 NPI: 1467982629 LIC: DN22548FL W-Th 8am - 5pm # DN22714 Fornes-Ferrero, (305) 514-0813 # DN6340 Drobes, David # DN19839 Gutierrez, Carlos Patricia Special Needs: Yes NPI: 1740478221 LIC: DN6340 General Dentist servicing as: General Dentist servicing as: English, Spanish Pediatric Dentistry NPI: 1861756603 LIC: DN19839 M-T 8:30 am - 5:30 pm # CHC8227 NPI: 1619407566 LIC: DN22714 CERTIFICATIONS: W-Th 8:30 am - 5:30 pm Borinquen Health Care # DN16377 • Inhalation Sedation Krasnov, Rostislav # DN14864 Henry, Stephen Center, INC # DN19249 Pria, Carlos NPI: 1942267935 LIC: DN16377 NPI: 1851455117 LIC: DN14864 3601 Federal Hwy, 5Th Floor NPI: 1811166838 LIC: DN19249 Miami, FL 33137 # 011430 # DN20641 Makary, Sara CERTIFICATIONS: NPI: 1851704654 LIC: DN20641 (305) 576-6611 • Inhalation Sedation C & C Dental, Inc. Special Needs: Yes • Board Certification 951 Ne 167 Street, #104 # DN25143 Rios, Christina English, Spanish, Creoles and # DN16074 Soheil, Michelle North Miami Beach, FL 33162 NPI: 1831701622 LIC: DN25143 Pidgins Portuguese-based(other), NPI: 1215014394 LIC: DN16074 (305) 493-9371 French, Persian (T), Portuguese Special Needs: Yes # FQHC9799 M-T 8am - 5pm # 009814 English, Spanish CAN Community Health, Inc. W 8am - 5pm, Th 8am - 6pm, F M-T 9am - 5pm 8am - 4pm Bravo Dental P.A. 18360 Nw 47Th Ave Miami Gardens, FL 33055 # DN19839 Gutierrez, Carlos 909 N. Miami Beach Blvd, Ste # DN19495 Casas, Silvia 501 (786) 800-5631 General Dentist servicing as: NPI: 1912295387 LIC: DN19495 North Miami Beach, FL 33162 Special Needs: Yes NPI: 1861756603 LIC: DN19839 (305) 945-9333 # FQHC012553 English, Spanish, Creoles and CERTIFICATIONS: Special Needs: Yes Camillus Health Concern, Pidgins English-based(other), • Inhalation Sedation French English, Spanish Inc. # DN19140 Mestre, Jairo M-T 8:30 am - 5:30 pm M-T 10am - 5pm 336 Nw 5Th St NPI: 1811202971 LIC: DN19140 W-Th 8:30 am - 5:30 pm W-F 10am - 5pm Miami, FL 33128 CERTIFICATIONS: # DN23140 # DN19497 Yanez Bravo, Maria (305) 341-0152 Feiz, Maria* • Inhalation Sedation Special Needs: Yes NPI: 1932615929 LIC: DN23140

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 36 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN12903 George, Deborah* # DN24481 Defaus Fernandez, # DN21495 Streett, Rosario NPI: 1124382866 LIC: DN20973 NPI: 1720149180 LIC: DN12903 Beatriz NPI: 1801230768 LIC: DN21495 # DN20674 Sardinas, Yoan* NPI: 1023558087 LIC: DN24481 # DN14864 Henry, Stephen* # DN24393 Vimo, Belen NPI: 1992118657 LIC: DN20674 # DN23705 Diaz Valle, Orlando NPI: 1851455117 LIC: DN14864 NPI: 1144879925 LIC: DN24393 NPI: 1457717290 LIC: DN23705 # 021891 # DN21713 Lebron, Vanessa* # DN23764 Wilkins, Lorena Care Smile, LLC # DN24104 Gonzalez Junco, Luis NPI: 1619336369 LIC: DN21713 NPI: 1669950192 LIC: DN23764 833 N. Homestead Blvd NPI: 1447819396 LIC: DN24104 # DN25148 Namen Alarcon, Homestead, FL 33030 # DN23700 Gonzalez, Carmen # 016489 Javier* (305) 245-3247 Care Resource NPI: 1255857801 LIC: DN25148 NPI: 1285110718 LIC: DN23700 Special Needs: No 1901 Sw 1St St # DN25143 Rios, Christina* # DN23529 Gonzalez, Giovanni English, Spanish, Creoles and Miami, FL 33135 Pidgins English-based(other) NPI: 1831701622 LIC: DN25143 NPI: 1417436189 LIC: DN23529 (305) 203-5230 M-T 8am - 5pm # DN19802 Hernandez, David # DN19661 Williams, Tosha* Special Needs: Yes W-F 8am - 5pm NPI 1609009463 LIC: DN19661 NPI: 1245593896 LIC: DN19802 English : # DN18847 De Vera, Vanessa* CERTIFICATIONS: # DN19522 Hernandez, Stephanie M-T 8am - 5:15 pm NPI: 1699006072 LIC: DN18847 • Inhalation Sedation NPI: 1669751871 LIC: DN19522 Th-F 8am - 5:15 pm # DN20903 Gomez Perez, Nils* # DN13731 Barnes, Curtis # DN23644 Martinez Morales, # EV1077556 NPI: 1346649118 LIC: DN20903 NPI: 1689798936 LIC: DN13731 Cano Dental Lesner NPI: 1619453743 LIC: DN23644 # DN18139 Casas, Manuel # 021892 13920 Sw 47Th St. Miami, FL 33175 # DN25261FL Montero, Yenisey NPI: 1740420090 LIC: DN18139 Care Smile, LLC (786) 408-6651 NPI: 1740786599 LIC: DN25261FL # DN20973 Martinez, Amy 9605 W. Flagler Street Special Needs: Yes # DN22889 Mostatabzadeh, Amir NPI: 1124382866 LIC: DN20973 Miami, FL 33174 English, Spanish (305) 559-0278 NPI: 1457883019 LIC: DN22889 # DN20674 Sardinas, Yoan M-T 8am - 5pm Special Needs: No NPI: 1992118657 LIC: DN20674 W-F 8am - 5pm # DN23899 Moya, Yudit English, Spanish, Creoles and NPI: 1144793233 LIC: DN23899 Pidgins English-based(other) # DN14815 Alcequiez, Zeneyda # CHC13129 M-T 8am - 5pm NPI: 1124241989 LIC: DN14815 # DN24672 Pilarte, Graciela Care Resource Community W-F 8am - 5pm NPI: 1548691017 LIC: DN24672 # DN23321 Aleman, Jose Health Centers # DN18847 De Vera, Vanessa* NPI: 1770061020 LIC: DN23321 # DN22255 Rajschmir, Silvina 3510 Biscayne Blvd, Ste 300 NPI: 1699006072 LIC: DN18847 General Dentist servicing as: Miami, FL 33137 # DN21645 Baez Henry, Pediatric Dentistry (305) 576-1234 # DN20903 Gomez Perez, Nils* Carlianette NPI: 1679977896 LIC: DN22255 Special Needs: Yes NPI: 1346649118 LIC: DN20903 NPI: 1235594961 LIC: DN21645 # DN22999 Reyes, Christina English, Spanish # DN15630 Cano, Lourdes M-T 8:30 am - 5pm # 021893 NPI: 1679931000 LIC: DN22999 NPI: 1093867947 LIC: DN15630 W-F 8:30 am - 5pm Care Smile, LLC # DN11150 Reyes, Miguel # DN21572 Carballo, Mauro # DN13731 Barnes, Curtis* 1840 W. 49Th Street, Ste 105 NPI: 1407948482 LIC: DN11150 NPI: 1508200635 LIC: DN21572 NPI: 1689798936 LIC: DN13731 Hialeah, FL 33012 # DN24107 Serhan Lopez, Nayef (305) 362-4382 # DN23695 Cruz, Yanet # DN18139 Casas, Manuel* NPI: 1184282550 LIC: DN24107 Special Needs: Yes NPI: 1508225376 LIC: DN23695 NPI: 1740420090 LIC: DN18139 # DN17332 Simon, Gelsys English, Spanish, Creoles and # DN20973 Martinez, Amy* Pidgins English-based(other) NPI: 1629154299 LIC: DN17332

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 37 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

M-T 8am - 5pm (305) 551-6714 NPI: 1215150909 LIC: DN11945 # DN20512 Cala-Morales, Angela W-F 8am - 5pm Special Needs: Yes # DN23756 Fernandez, Malena NPI: 1376823203 LIC: DN20512 English, Spanish # DN18847 De Vera, Vanessa* NPI: 1740756063 LIC: DN23756 # DN19206 Campbell, Lisa M-T 9am - 6pm NPI: 1699006072 LIC: DN18847 # DN24501 Jaime Garriga, Yanet NPI: 1659594497 LIC: DN19206 # DN13508 Martin, Ciro # DN20903 Gomez Perez, Nils* NPI: 1134605843 LIC: DN24501 # DN11945 Chin- Thompson, NPI: 1093855256 LIC: DN13508 NPI: 1346649118 LIC: DN20903 # DN10538 Johnson, Robert Angella # 011421 NPI: 1215150909 LIC: DN11945 # 021894 NPI: 1275600686 LIC: DN10538 Claudio L. Miro DDS # DN23756 Fernandez, Malena Care Smile, LLC # DN11108 Lang, Tomas 564 Sw 42 Ave, 2Nd Floor NPI: 1740756063 LIC: DN23756 1757 Sw 22Nd Street NPI: 1386758886 LIC: DN11108 Miami, FL 33134 # DN24501 Jaime Garriga, Yanet Miami, FL 33145 # DN17815 Lopez De Victoria, (305) 442-7444 (786) 442-1040 Millied NPI: 1134605843 LIC: DN24501 Special Needs: Yes Special Needs: Yes NPI: 1467405423 LIC: DN17815 # DN10538 Johnson, Robert English, Spanish English, Spanish, Creoles and M-T 9am - 5pm # DN13131 Miranda, Alejandra NPI: 1275600686 LIC: DN10538 Pidgins English-based(other) M-T 7am - 5pm # DN24293FL Llanos, Laura NPI: 1558328823 LIC: DN13131 # DN11108 Lang, Tomas W-F 7am - 5pm NPI: 1871154153 LIC: DN24293FL # DN14396 Watson-Hamilton, NPI: 1386758886 LIC: DN11108 Sheri # DN20903 Gomez Perez, Nils* # DN11650 Miro, Claudio # DN17815 Lopez De Victoria, NPI: 1053580639 LIC: DN14396 Millied NPI: 1346649118 LIC: DN20903 NPI: 1417024118 LIC: DN11650 NPI: 1467405423 LIC: DN17815 CERTIFICATIONS: # FQHC016391 # 019446 • Conscious Sedation # DN13131 Miranda, Alejandra Collazo Family Dental CFCE Pediatric & Family # DN16786 Miro, Kiara NPI: 1558328823 LIC: DN13131 Health & Wellness 285 Nw 27Th Ave Ste 21 NPI: 1427078625 LIC: DN16786 # DN20570 Rameau, Rejane 1825 Nw 167 St Ste 102 Miami, FL 33125 # DN16862 Trujillo, Alexander NPI LIC: Miami Gardens, FL 33056 (786) 238-7590 : 1659541175 DN20570 (305) 474-1800 NPI: 1043231996 LIC: DN16862 Special Needs: Yes # DN14396 Watson-Hamilton, Special Needs: Yes CERTIFICATIONS: English, Spanish Sheri • Conscious Sedation English, Spanish, Creoles and # DN20751 Ramos Collazo, NPI: 1053580639 LIC: DN14396 Pidgins (other) # FQHC7698 Yoaris M-T 9am - 5pm # FQHC014565 Clinica Campesina NPI: 1679982748 LIC: DN20751 W-F 9am - 5pm Community Health of South # DN21844 Brunet, Zeida 810 West Mowry Dr. # FQHC7697 Florida, Inc. Homestead, FL 33030 NPI: 1093164956 LIC: DN21844 Community Health Center 13540 Sw 135 Ave (305) 242-6078 Miami, FL 33186 10300 Sw 216Th Street # DN21846 Fonseca, Jacqueline Special Needs: Yes www.chisouthfl.org NPI: 1487005369 LIC: DN21846 Miami, FL 33190 English, Spanish, Creoles and (786) 231-0800 Pidgins French-based(other) (305) 253-5100 # DN24153 Kucharski, Melanie Special Needs: Yes M 8am - 7:30 pm, T 8am - 5:30 Special Needs: Yes NPI: 1265086060 LIC: DN24153 English, Spanish pm English, Chinese Mandarin, Creoles and Pidgins W-F 8:30 am - 6pm # 008230 # DN20512 Cala-Morales, Angela English-based(other), French, # DN20512 Cala-Morales, Angela Ciro A. Martin, DDS, PA NPI: 1376823203 LIC: DN20512 Polish, Spanish NPI: 1376823203 LIC: DN20512 8463 Bird Road # DN11945 Chin- Thompson, M-T 8:30 am - 7pm # DN19206 Campbell, Lisa Miami, FL 33155 Angella W-Th 8:30 am - 7pm

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 38 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1659594497 LIC: DN19206 # DN11945 Chin- Thompson, (305) 654-1234 # DN8463 Vazana, Raphael Special Needs: Yes # DN11945 Chin- Thompson, Angella NPI: 1528170107 LIC: DN8463 English, Russian, Creoles and Angella NPI: 1215150909 LIC: DN11945 Pidgins English-based(other), NPI: 1215150909 LIC: DN11945 # DN23756 Fernandez, Malena # 011412 Spanish David M. Adelman, DDS, PA # DN23756 Fernandez, Malena NPI: 1740756063 LIC: DN23756 M-T 10am - 5pm NPI: 1740756063 LIC: DN23756 # DN24501 Jaime Garriga, Yanet W-F 10am - 5pm 16680 Ne 10Th Ave North Miami Beach, FL 33162 # DN24501 Jaime Garriga, Yanet NPI: 1134605843 LIC: DN24501 # DN22387 Keane, Chris (305) 944-6669 NPI: 1831543909 LIC: DN22387 NPI: 1134605843 LIC: DN24501 # DN10538 Johnson, Robert Special Needs: Yes # DN10538 Johnson, Robert NPI: 1275600686 LIC: DN10538 English, Spanish # 007940 NPI 1275600686 LIC: DN10538 # DN11108 Lang, Tomas M 8:30 am - 5pm, T 8:30 am - : Crown Dental Corp 5:30 pm # DN11108 Lang, Tomas NPI: 1386758886 LIC: DN11108 10728 Sw 72Nd Street W 8:30 am - 5pm, Th 8:30 am - NPI: 1386758886 LIC: DN11108 # DN17815 Lopez De Victoria, Miami, FL 33173 5:30 pm, F 8:30 am - 12:30 pm # DN17815 Lopez De Victoria, Millied (305) 596-7155 # DN3881 Adelman, David NPI: 1467405423 LIC: DN17815 Special Needs: Yes Millied NPI: 1215053160 LIC: DN3881 English, Spanish NPI: 1467405423 LIC: DN17815 # DN13131 Miranda, Alejandra CERTIFICATIONS: M-T 9:30 am - 6pm # DN13131 Miranda, Alejandra NPI: 1558328823 LIC: DN13131 • Inhalation Sedation W-F 9:30 am - 6pm NPI: 1558328823 LIC: DN13131 # DN20570 Rameau, Rejane # 015505 # DN12593 Gonzalez, Lilian # DN20570 Rameau, Rejane NPI: 1659541175 LIC: DN20570 NPI: 1255436424 LIC: DN12593 De La Calle Dental Center NPI: 1659541175 LIC: DN20570 # DN14396 Watson-Hamilton, 10775 Sw 56Th St # DN14396 Watson-Hamilton, Sheri # 011899 Miami, FL 33165 Sheri NPI: 1053580639 LIC: DN14396 D & R Dentistry [email protected] NPI: 1053580639 LIC: DN14396 14750 Sw 26 St Ste 210 (305) 321-5927 # 022054 Miami, FL 33185 Special Needs: No # FQHC014566 Coral Gables Dental Health (305) 400-8060 English, Spanish Community Health of South Center Special Needs: Yes W-F 9am - 6pm 747 Ponce De Leon Blvd, Ste Florida, Inc. English, Spanish # DN21153 Lobaina, Karina 401 6350 Sunset Drive M-T 8:30 am - 6pm NPI: 1063895076 LIC: DN21153 Coral Gables, FL 33134 Miami, FL 33143 W-F 8:30 am - 6pm (305) 444-8591 (786) 293-5500 # 015414 Special Needs: No # DN18940 Rodriguez, Ramon Special Needs: Yes Dental Dreams LLC English, Spanish NPI: 1366768657 LIC: DN18940 English, Spanish, Creoles and 5632 Nw 167Th St Pidgins English-based(other) M 10am - 6pm, T 10am - 7pm # 009364 Miami, FL 33014 M 8:30 am - 5pm, T 10:30 am - W 10am - 7pm, Th 10am - 6pm, dentaldreams.com 7pm F 9am - 2pm David E Dewitt, DDS PA (305) 625-9777 W 8:30 am - 5pm, Th 10:30 am - # DN16140 Carballo, Rodolfo 4841 W 4Th Ave Special Needs: Yes 7pm, F 8:30 am - 5pm NPI: 1235466269 LIC: DN16140 Hialeah, FL 33012 English, Spanish # DN20512 Cala-Morales, Angela (305) 558-2261 M-T 9am - 5pm NPI: 1376823203 LIC: DN20512 # EV678691 Special Needs: Yes Countyline Dentisry PA Spanish, English # DN16291 Carpio, Jesus # DN19206 Campbell, Lisa # DN3920 Dewitt, David NPI: 1932281961 LIC: DN16291 NPI: 1659594497 LIC: DN19206 21457 Nw 2Nd Ave Miami, FL 33169 NPI: 1548372139 LIC: DN3920

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 39 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23644 Martinez Morales, W-F 8am - 5pm General Dentist servicing as: # EV1038364 Pediatric Dentistry Lesner # DN14815 Alcequiez, Zeneyda Dental Excellence Partners NPI: 1679977896 LIC: DN22255 NPI: 1619453743 LIC: DN23644 NPI: 1124241989 LIC: DN14815 4201 Palm Ave. # DN22999 Reyes, Christina # DN25261FL Montero, Yenisey # DN23321 Aleman, Jose Hialeah, FL 33012 NPI: 1679931000 LIC: DN22999 NPI: 1740786599 LIC: DN25261FL NPI: 1770061020 LIC: DN23321 (305) 456-6474 # DN11150 Reyes, Miguel Special Needs: Yes # DN22889 Mostatabzadeh, Amir # DN21645 Baez Henry, NPI: 1407948482 LIC: DN11150 English, Spanish NPI: 1457883019 LIC: DN22889 Carlianette M-T 8am - 5pm # DN23899 Moya, Yudit NPI: 1235594961 LIC: DN21645 # DN19389 Sanchez, Arnaldo W-F 8am - 5pm NPI LIC: NPI: 1144793233 LIC: DN23899 # DN15630 Cano, Lourdes : 1831486844 DN19389 # DN14815 Alcequiez, Zeneyda # DN24672 Pilarte, Graciela NPI: 1093867947 LIC: DN15630 # DN24107 Serhan Lopez, Nayef NPI: 1124241989 LIC: DN14815 NPI LIC: NPI: 1548691017 LIC: DN24672 # DN21572 Carballo, Mauro : 1184282550 DN24107 # DN23321 Aleman, Jose # DN22255 Rajschmir, Silvina NPI: 1508200635 LIC: DN21572 # DN17332 Simon, Gelsys NPI: 1770061020 LIC: DN23321 NPI LIC: General Dentist servicing as: # DN23695 Cruz, Yanet : 1629154299 DN17332 Pediatric Dentistry # DN21645 Baez Henry, NPI: 1508225376 LIC: DN23695 # DN24393 Vimo, Belen NPI: 1679977896 LIC: DN22255 Carlianette NPI LIC: # DN24481 Defaus Fernandez, : 1144879925 DN24393 NPI: 1235594961 LIC: DN21645 # DN22999 Reyes, Christina Beatriz # DN23764 Wilkins, Lorena NPI: 1679931000 LIC: DN22999 # DN15630 Cano, Lourdes NPI: 1023558087 LIC: DN24481 NPI: 1669950192 LIC: DN23764 NPI: 1093867947 LIC: DN15630 # DN11150 Reyes, Miguel # DN23705 Diaz Valle, Orlando # 019648 # DN21572 Carballo, Mauro NPI: 1407948482 LIC: DN11150 NPI: 1457717290 LIC: DN23705 Dental Excellence Partners, NPI: 1508200635 LIC: DN21572 # DN24107 Serhan Lopez, Nayef # DN24104 Gonzalez Junco, Luis LLC # DN23695 Cruz, Yanet NPI: 1184282550 LIC: DN24107 NPI: 1447819396 LIC: DN24104 4500 Nw 7Th St NPI: 1508225376 LIC: DN23695 # DN17332 Simon, Gelsys # DN23700 Gonzalez, Carmen Miami, FL 33126 # DN24481 Defaus Fernandez, NPI: 1629154299 LIC: DN17332 NPI: 1285110718 LIC: DN23700 (305) 443-9206 Beatriz # DN21495 Streett, Rosario Special Needs: Yes # DN19522 Hernandez, Stephanie NPI: 1023558087 LIC: DN24481 English, Spanish NPI: 1801230768 LIC: DN21495 NPI: 1669751871 LIC: DN19522 M-T 8am - 4pm # DN23705 Diaz Valle, Orlando # DN24393 Vimo, Belen # DN23644 Martinez Morales, NPI: 1457717290 LIC: DN23705 # DN14815 Alcequiez, Zeneyda NPI: 1144879925 LIC: DN24393 Lesner NPI: 1124241989 LIC: DN14815 # DN24104 Gonzalez Junco, Luis # DN23764 Wilkins, Lorena NPI: 1619453743 LIC: DN23644 NPI: 1447819396 LIC: DN24104 # DN23321 Aleman, Jose NPI: 1669950192 LIC: DN23764 # DN25261FL Montero, Yenisey NPI: 1770061020 LIC: DN23321 # DN23700 Gonzalez, Carmen NPI: 1740786599 LIC: DN25261FL # EV699029 NPI: 1285110718 LIC: DN23700 # DN21645 Baez Henry, # DN22889 Mostatabzadeh, Amir Dental Excellence Partners Carlianette # DN23529 Gonzalez, Giovanni NPI: 1457883019 LIC: DN22889 LLC NPI: 1235594961 LIC: DN21645 NPI: 1417436189 LIC: DN23529 # DN23899 Moya, Yudit 1 Glen Royal Parkway # DN15630 Cano, Lourdes # DN19802 Hernandez, David Miami, FL 33125 NPI: 1144793233 LIC: DN23899 NPI: 1093867947 LIC: DN15630 NPI: 1245593896 LIC: DN19802 (305) 847-9915 # DN24672 Pilarte, Graciela Special Needs: Yes # DN21572 Carballo, Mauro # DN19522 Hernandez, Stephanie NPI: 1548691017 LIC: DN24672 English, Spanish NPI: 1508200635 LIC: DN21572 NPI: 1669751871 LIC: DN19522 M-T 8am - 5pm # DN22255 Rajschmir, Silvina

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 40 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN24362 Cortes Fontanet, NPI: 1407948482 LIC: DN11150 # DN24481 Defaus Fernandez, # DN17332 Simon, Gelsys Raisa # DN19389 Sanchez, Arnaldo Beatriz NPI: 1629154299 LIC: DN17332 NPI: 1124505268 LIC: DN24362 NPI: 1023558087 LIC: DN24481 NPI: 1831486844 LIC: DN19389 # DN21495 Streett, Rosario # DN23695 Cruz, Yanet # DN24107 Serhan Lopez, Nayef # DN23705 Diaz Valle, Orlando NPI: 1801230768 LIC: DN21495 NPI: 1508225376 LIC: DN23695 NPI: 1457717290 LIC: DN23705 NPI: 1184282550 LIC: DN24107 # DN24393 Vimo, Belen # DN24481 Defaus Fernandez, # DN17332 Simon, Gelsys # DN24104 Gonzalez Junco, Luis NPI: 1144879925 LIC: DN24393 Beatriz NPI: 1447819396 LIC: DN24104 NPI: 1629154299 LIC: DN17332 # DN23764 Wilkins, Lorena NPI: 1023558087 LIC: DN24481 # DN21495 Streett, Rosario # DN23700 Gonzalez, Carmen NPI: 1669950192 LIC: DN23764 # DN23705 Diaz Valle, Orlando NPI: 1801230768 LIC: DN21495 NPI: 1285110718 LIC: DN23700 NPI: 1457717290 LIC: DN23705 # 019657 # DN24393 Vimo, Belen # DN23529 Gonzalez, Giovanni # DN24104 Gonzalez Junco, Luis Dental Excellence Partners, NPI: 1144879925 LIC: DN24393 NPI: 1417436189 LIC: DN23529 NPI: 1447819396 LIC: DN24104 LLC # DN19802 Hernandez, David # DN23764 Wilkins, Lorena 3825 W. 16Th Ave # DN23700 Gonzalez, Carmen NPI: 1669950192 LIC: DN23764 NPI: 1245593896 LIC: DN19802 Hialeah, FL 33012 NPI: 1285110718 LIC: DN23700 # DN19522 Hernandez, Stephanie (786) 501-2166 # DN23529 Gonzalez, Giovanni # 019649 NPI: 1669751871 LIC: DN19522 Special Needs: Yes NPI: 1417436189 LIC: DN23529 Dental Excellence Partners, English, Spanish # DN23644 Martinez Morales, LLC M-T 8am - 5pm # DN19802 Hernandez, David Lesner 8300 W. Flager Ste 210 W-F 8am - 5pm NPI: 1245593896 LIC: DN19802 NPI: 1619453743 LIC: DN23644 Miami, FL 33144 # DN14815 Alcequiez, Zeneyda # DN19522 Hernandez, Stephanie (786) 534-2796 # DN25261FL Montero, Yenisey NPI: 1124241989 LIC: DN14815 NPI: 1669751871 LIC: DN19522 Special Needs: Yes NPI: 1740786599 LIC: DN25261FL English, Spanish # DN23321 Aleman, Jose # DN23644 Martinez Morales, # DN22889 Mostatabzadeh, Amir M-T 8am - 5pm NPI: 1770061020 LIC: DN23321 Lesner NPI: 1457883019 LIC: DN22889 NPI: 1619453743 LIC: DN23644 W-F 8am - 5pm # DN21645 Baez Henry, # DN23899 Moya, Yudit Carlianette # DN25261FL Montero, Yenisey # DN14815 Alcequiez, Zeneyda NPI: 1144793233 LIC: DN23899 NPI: 1235594961 LIC: DN21645 NPI: 1740786599 LIC: DN25261FL NPI: 1124241989 LIC: DN14815 # DN24672 Pilarte, Graciela # DN15630 Cano, Lourdes # DN22889 Mostatabzadeh, Amir # DN23321 Aleman, Jose NPI: 1548691017 LIC: DN24672 NPI: 1093867947 LIC: DN15630 NPI: 1457883019 LIC: DN22889 NPI: 1770061020 LIC: DN23321 # DN22255 Rajschmir, Silvina # DN21645 Baez Henry, # DN21572 Carballo, Mauro # DN23899 Moya, Yudit General Dentist servicing as: Carlianette NPI: 1508200635 LIC: DN21572 NPI: 1144793233 LIC: DN23899 Pediatric Dentistry NPI: 1235594961 LIC: DN21645 # DN23695 Cruz, Yanet # DN24672 Pilarte, Graciela NPI: 1679977896 LIC: DN22255 # DN22998 Boeras Garcia, Suibel NPI: 1508225376 LIC: DN23695 NPI: 1548691017 LIC: DN24672 # DN22999 Reyes, Christina NPI: 1063939890 LIC: DN22998 # DN24481 Defaus Fernandez, # DN22255 Rajschmir, Silvina NPI: 1679931000 LIC: DN22999 # DN15630 Cano, Lourdes Beatriz General Dentist servicing as: # DN11150 Reyes, Miguel NPI: 1093867947 LIC: DN15630 NPI: 1023558087 LIC: DN24481 Pediatric Dentistry NPI: 1407948482 LIC: DN11150 NPI: 1679977896 LIC: DN22255 # DN21572 Carballo, Mauro # DN23705 Diaz Valle, Orlando # DN19389 Sanchez, Arnaldo # DN22999 Reyes, Christina NPI: 1508200635 LIC: DN21572 NPI: 1457717290 LIC: DN23705 NPI: 1831486844 LIC: DN19389 NPI: 1679931000 LIC: DN22999 # DN23695 Cruz, Yanet # DN24104 Gonzalez Junco, Luis # DN24107 Serhan Lopez, Nayef # DN11150 Reyes, Miguel NPI: 1508225376 LIC: DN23695 NPI: 1447819396 LIC: DN24104 NPI: 1184282550 LIC: DN24107

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 41 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23700 Gonzalez, Carmen # DN23764 Wilkins, Lorena # DN19522 Hernandez, Stephanie Hialeah, FL 33012 (305) 826-5224 NPI: 1285110718 LIC: DN23700 NPI: 1669950192 LIC: DN23764 NPI: 1669751871 LIC: DN19522 Special Needs: Yes # DN23529 Gonzalez, Giovanni # DN23644 Martinez Morales, # 019658 English, Spanish Lesner NPI: 1417436189 LIC: DN23529 Dental Excellence Partners, M-T 8am - 5pm NPI: 1619453743 LIC: DN23644 # DN19802 Hernandez, David LLC W-F 8am - 5pm NPI: 1245593896 LIC: DN19802 6801 Sw 8Th St. # DN25261FL Montero, Yenisey # DN14815 Alcequiez, Zeneyda NPI: 1740786599 LIC: DN25261FL # DN19522 Hernandez, Stephanie Miami, FL 33144 NPI: 1124241989 LIC: DN14815 (786) 501-2168 NPI: 1669751871 LIC: DN19522 # DN22889 Mostatabzadeh, Amir # DN23321 Aleman, Jose Special Needs: Yes NPI: 1457883019 LIC: DN22889 # DN23644 NPI: 1770061020 LIC: DN23321 Martinez Morales, English, Spanish # DN23899 Moya, Yudit Lesner M-T 8am - 5pm # DN21645 Baez Henry, NPI: 1619453743 LIC: DN23644 W-F 8am - 5pm NPI: 1144793233 LIC: DN23899 Carlianette

# DN25261FL Montero, Yenisey # DN14815 Alcequiez, Zeneyda # DN24672 Pilarte, Graciela NPI: 1235594961 LIC: DN21645 NPI: 1740786599 LIC: DN25261FL NPI: 1124241989 LIC: DN14815 NPI: 1548691017 LIC: DN24672 # DN15630 Cano, Lourdes

# DN22889 Mostatabzadeh, Amir # DN23321 Aleman, Jose # DN22255 Rajschmir, Silvina NPI: 1093867947 LIC: DN15630 NPI: 1457883019 LIC: DN22889 NPI: 1770061020 LIC: DN23321 General Dentist servicing as: # DN21572 Carballo, Mauro Pediatric Dentistry # DN23899 Moya, Yudit # DN21645 Baez Henry, NPI: 1508200635 LIC: DN21572 NPI: 1679977896 LIC: DN22255 NPI: 1144793233 LIC: DN23899 Carlianette # DN23695 Cruz, Yanet # DN22999 Reyes, Christina # DN24672 Pilarte, Graciela NPI: 1235594961 LIC: DN21645 NPI: 1508225376 LIC: DN23695 NPI: 1679931000 LIC: DN22999 NPI: 1548691017 LIC: DN24672 # DN15630 Cano, Lourdes # DN24481 Defaus Fernandez, # DN11150 Reyes, Miguel # DN22255 Rajschmir, Silvina NPI: 1093867947 LIC: DN15630 Beatriz NPI: 1407948482 LIC: DN11150 General Dentist servicing as: # DN21572 Carballo, Mauro NPI: 1023558087 LIC: DN24481 Pediatric Dentistry # DN19389 Sanchez, Arnaldo NPI: 1508200635 LIC: DN21572 # DN23705 Diaz Valle, Orlando NPI: 1679977896 LIC: DN22255 NPI: 1831486844 LIC: DN19389 # DN23695 Cruz, Yanet NPI: 1457717290 LIC: DN23705 # DN22999 Reyes, Christina # DN24107 Serhan Lopez, Nayef NPI: 1508225376 LIC: DN23695 # DN24104 Gonzalez Junco, Luis NPI: 1679931000 LIC: DN22999 NPI: 1184282550 LIC: DN24107 # DN24481 Defaus Fernandez, NPI: 1447819396 LIC: DN24104 # DN11150 Reyes, Miguel # DN17332 Simon, Gelsys Beatriz # DN23700 Gonzalez, Carmen NPI: 1407948482 LIC: DN11150 NPI: 1629154299 LIC: DN17332 NPI: 1023558087 LIC: DN24481 NPI: 1285110718 LIC: DN23700 # DN19389 Sanchez, Arnaldo # DN21495 Streett, Rosario # DN23705 Diaz Valle, Orlando # DN23529 Gonzalez, Giovanni NPI: 1831486844 LIC: DN19389 NPI: 1801230768 LIC: DN21495 NPI: 1457717290 LIC: DN23705 NPI: 1417436189 LIC: DN23529 # DN24107 Serhan Lopez, Nayef # DN24393 Vimo, Belen # DN24104 Gonzalez Junco, Luis # DN19802 Hernandez, David NPI: 1184282550 LIC: DN24107 NPI: 1144879925 LIC: DN24393 NPI: 1447819396 LIC: DN24104 NPI: 1245593896 LIC: DN19802 # DN17332 Simon, Gelsys # DN23764 Wilkins, Lorena # DN23700 Gonzalez, Carmen # DN19522 Hernandez, Stephanie NPI: 1629154299 LIC: DN17332 NPI: 1669950192 LIC: DN23764 NPI: 1285110718 LIC: DN23700 NPI: 1669751871 LIC: DN19522 # DN21495 Streett, Rosario # DN23529 Gonzalez, Giovanni # 019659 # DN23644 Martinez Morales, NPI: 1801230768 LIC: DN21495 NPI: 1417436189 LIC: DN23529 Dental Excellence Partners, Lesner # DN24393 Vimo, Belen # DN19802 Hernandez, David LLC NPI: 1619453743 LIC: DN23644 NPI: 1144879925 LIC: DN24393 NPI: 1245593896 LIC: DN19802 4410 W. 16Th Ave #58 # DN25261FL Montero, Yenisey

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 42 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1740786599 LIC: DN25261FL M-T 8am - 5pm NPI: 1740786599 LIC: DN25261FL M-T 8am - 5pm W-F 8am - 5pm W-F 8am - 5pm # DN22889 Mostatabzadeh, Amir # DN22889 Mostatabzadeh, Amir NPI: 1457883019 LIC: DN22889 # DN14815 Alcequiez, Zeneyda NPI: 1457883019 LIC: DN22889 # DN14815 Alcequiez, Zeneyda NPI: 1124241989 LIC: DN14815 NPI: 1124241989 LIC: DN14815 # DN23899 Moya, Yudit # DN23899 Moya, Yudit NPI: 1144793233 LIC: DN23899 # DN23321 Aleman, Jose NPI: 1144793233 LIC: DN23899 # DN23321 Aleman, Jose NPI: 1770061020 LIC: DN23321 NPI: 1770061020 LIC: DN23321 # DN24672 Pilarte, Graciela # DN24672 Pilarte, Graciela NPI: 1548691017 LIC: DN24672 # DN21645 Baez Henry, NPI: 1548691017 LIC: DN24672 # DN21645 Baez Henry, Carlianette Carlianette # DN22255 Rajschmir, Silvina # DN22255 Rajschmir, Silvina NPI: 1235594961 LIC: DN21645 NPI: 1235594961 LIC: DN21645 General Dentist servicing as: General Dentist servicing as: Pediatric Dentistry # DN22998 Boeras Garcia, Suibel Pediatric Dentistry # DN22998 Boeras Garcia, Suibel NPI: 1679977896 LIC: DN22255 NPI: 1063939890 LIC: DN22998 NPI: 1679977896 LIC: DN22255 NPI: 1063939890 LIC: DN22998

# DN22999 Reyes, Christina # DN15630 Cano, Lourdes # DN22999 Reyes, Christina # DN15630 Cano, Lourdes NPI: 1679931000 LIC: DN22999 NPI: 1093867947 LIC: DN15630 NPI: 1679931000 LIC: DN22999 NPI: 1093867947 LIC: DN15630

# DN11150 Reyes, Miguel # DN21572 Carballo, Mauro # DN11150 Reyes, Miguel # DN21572 Carballo, Mauro NPI: 1407948482 LIC: DN11150 NPI: 1508200635 LIC: DN21572 NPI: 1407948482 LIC: DN11150 NPI: 1508200635 LIC: DN21572

# DN24069 Rodriguez Gonzalez, # DN23886 Castellanos, Nicholas # DN24069 Rodriguez Gonzalez, # DN23695 Cruz, Yanet David NPI: 1497228621 LIC: DN23886 David NPI: 1508225376 LIC: DN23695 NPI: 1548798960 LIC: DN24069 NPI: 1548798960 LIC: DN24069 # DN23695 Cruz, Yanet # DN24481 Defaus Fernandez, # DN19389 Sanchez, Arnaldo NPI: 1508225376 LIC: DN23695 # DN19389 Sanchez, Arnaldo Beatriz NPI: 1831486844 LIC: DN19389 NPI: 1831486844 LIC: DN19389 NPI: 1023558087 LIC: DN24481 # DN24481 Defaus Fernandez, # DN24107 Serhan Lopez, Nayef Beatriz # DN24107 Serhan Lopez, Nayef # DN23705 Diaz Valle, Orlando NPI: 1184282550 LIC: DN24107 NPI: 1023558087 LIC: DN24481 NPI: 1184282550 LIC: DN24107 NPI: 1457717290 LIC: DN23705

# DN17332 Simon, Gelsys # DN23705 Diaz Valle, Orlando # DN17332 Simon, Gelsys # DN24104 Gonzalez Junco, Luis NPI: 1629154299 LIC: DN17332 NPI: 1457717290 LIC: DN23705 NPI: 1629154299 LIC: DN17332 NPI: 1447819396 LIC: DN24104

# DN21495 Streett, Rosario # DN24104 Gonzalez Junco, Luis # DN21495 Streett, Rosario # DN23700 Gonzalez, Carmen NPI: 1801230768 LIC: DN21495 NPI: 1447819396 LIC: DN24104 NPI: 1801230768 LIC: DN21495 NPI: 1285110718 LIC: DN23700

# DN24393 Vimo, Belen # DN23700 Gonzalez, Carmen # DN24393 Vimo, Belen # DN23529 Gonzalez, Giovanni NPI: 1144879925 LIC: DN24393 NPI: 1285110718 LIC: DN23700 NPI: 1144879925 LIC: DN24393 NPI: 1417436189 LIC: DN23529

# DN23764 Wilkins, Lorena # DN23529 Gonzalez, Giovanni # DN23764 Wilkins, Lorena # DN19802 Hernandez, David NPI: 1669950192 LIC: DN23764 NPI: 1417436189 LIC: DN23529 NPI: 1669950192 LIC: DN23764 NPI: 1245593896 LIC: DN19802

# DN19802 Hernandez, David # DN19522 Hernandez, Stephanie # 020098 # 020099 NPI: 1245593896 LIC: DN19802 NPI: 1669751871 LIC: DN19522 Dental Excellence Partners, Dental Excellence Partners, LLC # DN19522 Hernandez, Stephanie LLC # DN23644 Martinez Morales, 266 E 49Th St NPI: 1669751871 LIC: DN19522 5190 Nw 167Th Ave Ste 109 Lesner NPI: 1619453743 LIC: DN23644 Hialeah, FL 33013 # DN23644 Martinez Morales, Miami Lakes, FL 33014 (305) 823-9982 Lesner (786) 431-2238 # DN25261FL Montero, Yenisey Special Needs: Yes NPI: 1619453743 LIC: DN23644 Special Needs: Yes NPI: 1740786599 LIC: DN25261FL English, Spanish English, Spanish # DN25261FL Montero, Yenisey # DN22889 Mostatabzadeh, Amir

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 43 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1457883019 LIC: DN22889 NPI: 1770061020 LIC: DN23321 General Dentist servicing as: W-F 9am - 6pm Pediatric Dentistry # DN23899 Moya, Yudit # DN21645 Baez Henry, # DN17638 Alvarez, Maria NPI: 1679977896 LIC: DN22255 NPI: 1144793233 LIC: DN23899 Carlianette General Dentist servicing as: NPI: 1235594961 LIC: DN21645 # DN22999 Reyes, Christina Endodontics # DN24672 Pilarte, Graciela NPI: 1679931000 LIC: DN22999 NPI: 1124165303 LIC: DN17638 NPI: 1548691017 LIC: DN24672 # DN15630 Cano, Lourdes NPI: 1093867947 LIC: DN15630 # DN11150 Reyes, Miguel # DN22255 Rajschmir, Silvina # 008978 NPI: 1407948482 LIC: DN11150 General Dentist servicing as: # DN21572 Carballo, Mauro Dental Group of South Pediatric Dentistry NPI: 1508200635 LIC: DN21572 # DN19389 Sanchez, Arnaldo Florida II, Inc NPI: 1679977896 LIC: DN22255 NPI: 1831486844 LIC: DN19389 11336 Sw 184Th St # DN23695 Cruz, Yanet Miami, FL 33157 # DN22999 Reyes, Christina NPI: 1508225376 LIC: DN23695 # DN24107 Serhan Lopez, Nayef (305) 251-4262 NPI: 1679931000 LIC: DN22999 NPI: 1184282550 LIC: DN24107 # DN24481 Defaus Fernandez, Special Needs: Yes # DN11150 Reyes, Miguel # DN17332 Simon, Gelsys Beatriz English, Spanish NPI: 1407948482 LIC: DN11150 NPI: 1023558087 LIC: DN24481 NPI: 1629154299 LIC: DN17332 M-T 9am - 6pm # DN19389 Sanchez, Arnaldo # DN23705 Diaz Valle, Orlando # DN21495 Streett, Rosario W-F 9am - 6pm NPI: 1831486844 LIC: DN19389 NPI: 1457717290 LIC: DN23705 NPI: 1801230768 LIC: DN21495 # DN17638 Alvarez, Maria

# DN24107 Serhan Lopez, Nayef # DN24104 Gonzalez Junco, Luis # DN24393 Vimo, Belen General Dentist servicing as: Endodontics NPI: 1184282550 LIC: DN24107 NPI: 1447819396 LIC: DN24104 NPI: 1144879925 LIC: DN24393 NPI: 1124165303 LIC: DN17638 # DN17332 Simon, Gelsys # DN23700 Gonzalez, Carmen # DN23764 Wilkins, Lorena # DN20905 Rodriguez Castro, NPI: 1629154299 LIC: DN17332 NPI: 1285110718 LIC: DN23700 NPI: 1669950192 LIC: DN23764 Miriam # DN21495 Streett, Rosario # DN23529 Gonzalez, Giovanni # 009925 NPI: 1992051700 LIC: DN20905 NPI: 1801230768 LIC: DN21495 NPI: 1417436189 LIC: DN23529 Dental Group of Miami # 009361 # DN24393 Vimo, Belen # DN19802 Hernandez, David Beach Dental Group of South NPI: 1144879925 LIC: DN24393 NPI: 1245593896 LIC: DN19802 1010 71 Street Florida III # DN23764 Wilkins, Lorena # DN19522 Hernandez, Stephanie Miami Beach, FL 33141 101 Westward Dr. Ste A NPI: 1669950192 LIC: DN23764 (305) 868-8500 NPI: 1669751871 LIC: DN19522 Miami Springs, FL 33166 Special Needs: Yes # DN23644 Martinez Morales, www.dentalsfl.com # 020101 English, Spanish Lesner (305) 885-1357 Dental Excellence Partners, M-T 9am - 5pm NPI: 1619453743 LIC: DN23644 Special Needs: No LLC # DN19274 Quintana, Vilma English, Spanish # DN25261FL Montero, Yenisey 13768 Sw 8Th St NPI: 1598064354 LIC: DN19274 M-T 9am - 6pm Miami, FL 33184 NPI: 1740786599 LIC: DN25261FL # DN17638 Alvarez, Maria (786) 501-2163 # DN22889 Mostatabzadeh, Amir # 022853 General Dentist servicing as: Special Needs: Yes Dental Group of South NPI: 1457883019 LIC: DN22889 Endodontics English, Spanish Florida # DN23899 Moya, Yudit NPI: 1124165303 LIC: DN17638 M-T 8am - 5pm 13419 Sw 56Th Street NPI: 1144793233 LIC: DN23899 W-F 8am - 5pm Miami, FL 33175 # 016140 # DN24672 Pilarte, Graciela # DN14815 Alcequiez, Zeneyda (305) 559-2663 Dental Group of South NPI: 1548691017 LIC: DN24672 Special Needs: Yes NPI: 1124241989 LIC: DN14815 Florida IV Inc English, Spanish # DN23321 Aleman, Jose # DN22255 Rajschmir, Silvina 11373 Sw 211Th Street, Ste 10 M-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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 44 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Miami, FL 33189 279 Nw 82 Ave www.clubatlantisdental.com (305) 643-1444 www.dentalsfl.com Miami, FL 33126 (305) 672-9698 Special Needs: No (786) 250-5088 (305) 456-4592 Special Needs: Yes English, Spanish Special Needs: Yes Special Needs: Yes English, Spanish M-T 9am - 5pm

English, Spanish English M-T 9am - 5pm # DN13559 Guerra, Edy M-T 9am - 6pm M-T 9am - 5pm W-F 9am - 5pm NPI: 1174749691 LIC: DN13559 W-F 9am - 6pm W-F 9am - 5pm # DN12959 Santeiro, Alfredo # DN17638 Alvarez, Maria # DN18471 Blanco, Diana General Dentist servicing as: # 012702 General Dentist servicing as: NPI: 1659536043 LIC: DN18471 Endodontics Elizabeth De Aguirre DDS NPI: 1669602629 LIC: DN12959 Endodontics 806 S Douglas Rd Ste 150 # CHC012593 NPI: 1124165303 LIC: DN17638 Coral Gables, FL 33134 # 016275 DOH - Miami Dade Jefferson (305) 446-2226 # 022882 Reeves Clinic Dr. Jauregui Dental Care Special Needs: Yes Dental Group of South 1009 Nw 5Th Ave Corp English, Spanish Florida V Miami, FL 33136 5757 Sw 8Th Street, Ste 115 # DN15008 De Aguirre, Elizabeth 16830 Sw 88Th Street (786) 845-0164 Miami, FL 33144 NPI: 1467434746 LIC: DN15008 Miami, FL 33196 Special Needs: Yes wwwdrjauregui (305) 388-4886 English, Spanish (305) 269-1781 # 008275 Special Needs: No Special Needs: Yes # DN12747 Martin, Rosa* Elizabeth De Aguirre, D.D.S., English, Spanish English, Spanish NPI: 1538373428 LIC: DN12747 M-T 9am - 6pm M-T 9am - 5pm P.A. W-F 9am - 6pm # DN17940 Subirats, Ibelys* W-F 9am - 5pm 2750 W. 68 St, Ste 108 NPI: 1811193972 LIC: DN17940 Hialeah, FL 33016 # DN17638 Alvarez, Maria # DN21055 Jauregui, Guillermo (305) 826-3255 General Dentist servicing as: NPI: 1124375647 LIC: DN21055 # CHC014620 Special Needs: Yes Endodontics DOH - Miami-Dade County English, Spanish NPI: 1124165303 LIC: DN17638 # 012061 M-T 9am - 6pm Health Department Dr. Jean-Jacques Edderai, 971 Nw 2Nd St W-F 9am - 6pm # 012990 DDS PA Miami, FL 33128 # DN15008 De Aguirre, Elizabeth Dental Plus Inc. 17101 Ne 19Th Ave, Ste 104 (305) 575-3800 NPI: 1467434746 LIC: DN15008 11352 Quail Roost Dr North Miami Beach, FL 33162 Special Needs: Yes Miami, FL 33157 (305) 947-7999 English, Spanish # 017955 (305) 969-2651 Special Needs: Yes M-T 8am - 5pm Special Needs: Yes English, Spanish, French, Hebrew Empire Corporation W-Th 8am - 5pm English, Spanish M-T 8am - 5pm 2030 Nw 22Nd Ave M-T 9am - 6pm # DN12747 Martin, Rosa W 12pm - 7pm, Th 8am - 5pm, F Miami, FL 33142 W-F 9am - 6pm NPI: 1538373428 LIC: DN12747 9am - 1pm (305) 631-2963 Special Needs: Yes # DN19504 Cordova-Pena, Noris # DN17940 Subirats, Ibelys # DN12836 Edderai, Jean English, Spanish NPI: 1669754578 LIC: DN19504 NPI: 1811193972 LIC: DN17940 NPI: 1598981227 LIC: DN12836 M-T 9am - 5pm # DN24547 Egharevba, Paula # 007974 # 008240 W-F 9am - 5pm NPI: 1740681451 LIC: DN24547 Dr. Alfredo Santeiro, DDS Edy A. Guerra, DDS # DN14173 Bobadilla, Patricia NPI: 1124039672 LIC: DN14173 # 012876 2555 Collins Ave, Ste C3 4011 West Flagler Street, Ste #506 Diana R. Blanco, DMD, PLLC Miami Beach, FL 33140 Miami, FL 33134 # 011567

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 45 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Estetica Dental Gables Inc NPI: 1912359266 LIC: DN21994 NPI: 1598146755 LIC: DN21249 # 009424 4411 West Flagler Street # DN22100 Corugedo, Ada # DN21179 Reyes Canal, Osmil Family and Cosmetic Miami, FL 33134 NPI: 1568814747 LIC: DN22100 NPI: 1356732275 LIC: DN21179 (305) 445-5515 Dentistry # DN22964 Delgado Rey, Ivette # DN13492 Salcines, Damaris Special Needs: Yes 125 Ne 8Th St Ste 1 NPI: 1679097869 LIC: DN22964 Homestead, FL 33030 NPI: 1891705091 LIC: DN13492 English, Spanish (305) 245-6458 M-T 9am - 6pm # DN24494 Gandara, Maria # DN23323 Sanchez, Marlie Special Needs: Yes W-F 9am - 6pm NPI: 1073046603 LIC: DN24494 NPI: 1891287462 LIC: DN23323 English, Spanish # DN19582 Valdes, Marilyn # DN21579 Garcia, Idalmes # DN22991 Santiesteban, Aymara M-T 9am - 6pm General Dentist servicing as: NPI: 1245675107 LIC: DN21579 W-F 9am - 6pm NPI: 1265826168 LIC: DN22991 Endodontics # DN21977 Garrote, Rogelio # DN20482 Valdes, Martha NPI: 1104103910 LIC: DN19582 # DN25215 Alvarez Fleites, Susel NPI: 1144671470 LIC: DN21977 NPI: 1508476078 LIC: DN25215 General Dentist servicing as: # 011876 Endodontics # DN13322 Gomara, Luis # DN23163 Castro, Eileen NPI: 1649605585 LIC: DN20482 Excellence in Dental Care NPI: 1659381879 LIC: DN13322 NPI: 1518348796 LIC: DN23163 # DN24491 Zerquis Molina, 3706 W 12Th Ave # DN21830 Guerra-Crespa, # DN21994 Cortes Morales, Manuel Hialeah, FL 33012 Beatriz Guillermo NPI: 1598205718 LIC: DN24491 (305) 557-6661 NPI: 1376960658 LIC: DN21830 NPI: 1912359266 LIC: DN21994 Special Needs: Yes # DN18680 Hernandez-Baco, # 009425 English, Spanish # DN22100 Corugedo, Ada Karen Family and Cosmetic M-T 9am - 6pm NPI: 1568814747 LIC: DN22100 NPI: 1952623993 LIC: DN18680 Dentistry W 9am - 6am, Th 9am - 6pm, F # DN22964 Delgado Rey, Ivette 9am - 1pm # DN22276 Pena-Marro, Blanca 13706 Sw 56Th St Ste 201 NPI: 1679097869 LIC: DN22964 Miami, FL 33175 # DN17118 Alvarez, Rosa NPI: 1043620099 LIC: DN22276 # DN24494 Gandara, Maria www.familyplusdentalcenters.co NPI: 1306944533 LIC: DN17118 # DN21249 Prieto, Evelyn NPI: 1073046603 LIC: DN24494 m NPI: 1598146755 LIC: DN21249 (305) 387-4954 # 009426 # DN21579 Garcia, Idalmes # DN21179 Reyes Canal, Osmil Special Needs: Yes NPI: 1245675107 LIC: DN21579 Family and Cometic English, Spanish NPI: 1356732275 LIC: DN21179 Dentistry # DN21977 Garrote, Rogelio M-T 9am - 6pm # DN13492 Salcines, Damaris 4300 W. Flagler St Ste 201 NPI: 1144671470 LIC: DN21977 W-F 9am - 6pm Miami, FL 33134 NPI: 1891705091 LIC: DN13492 # DN13322 Gomara, Luis # DN25215 Alvarez Fleites, Susel (305) 888-0008 # DN23323 Sanchez, Marlie Special Needs: Yes NPI: 1659381879 LIC: DN13322 NPI: 1508476078 LIC: DN25215 NPI: 1891287462 LIC: DN23323 English, Spanish # DN21830 Guerra-Crespa, # DN23163 Castro, Eileen # DN22991 M-T 11am - 6pm Santiesteban, Aymara Beatriz NPI: 1518348796 LIC: DN23163 W 11am - 6pm, Th 9am - 6pm, F NPI: 1265826168 LIC: DN22991 NPI: 1376960658 LIC: DN21830 # DN21994 Cortes Morales, 11am - 6pm # DN20482 Valdes, Martha # DN18680 Hernandez-Baco, Guillermo # DN25215 Alvarez Fleites, Susel General Dentist servicing as: Karen NPI: 1912359266 LIC: DN21994 NPI: 1508476078 LIC: DN25215 Endodontics NPI: 1952623993 LIC: DN18680 # DN22100 Corugedo, Ada NPI: 1649605585 LIC: DN20482 # DN23163 Castro, Eileen # DN22276 Pena-Marro, Blanca NPI: 1568814747 LIC: DN22100 # DN24491 Zerquis Molina, NPI: 1518348796 LIC: DN23163 NPI: 1043620099 LIC: DN22276 Manuel # DN22964 Delgado Rey, Ivette # DN21994 Cortes Morales, # DN21249 Prieto, Evelyn NPI: 1598205718 LIC: DN24491 NPI: 1679097869 LIC: DN22964 Guillermo

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 46 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN24494 Gandara, Maria (786) 800-0171 NPI: 1891287462 LIC: DN23323 # DN21830 Guerra-Crespa, Special Needs: Yes NPI: 1073046603 LIC: DN24494 # DN22991 Santiesteban, Aymara Beatriz English, Spanish NPI: 1376960658 LIC: DN21830 # DN21579 NPI: 1265826168 LIC: DN22991 Garcia, Idalmes W-F 9am - 4pm NPI: 1245675107 LIC: DN21579 # DN20482 Valdes, Martha # DN18680 Hernandez-Baco, # DN25215 Alvarez Fleites, Susel General Dentist servicing as: Karen # DN21977 Garrote, Rogelio NPI: 1508476078 LIC: DN25215 Endodontics NPI: 1952623993 LIC: DN18680 NPI: 1144671470 LIC: DN21977 # DN23163 Castro, Eileen NPI: 1649605585 LIC: DN20482 # DN21249 Prieto, Evelyn # DN13322 Gomara, Luis NPI: 1518348796 LIC: DN23163 # DN24491 Zerquis Molina, NPI: 1598146755 LIC: DN21249 NPI: 1659381879 LIC: DN13322 # DN21994 Cortes Morales, Manuel # DN21179 Reyes Canal, Osmil # DN21830 Guerra-Crespa, Guillermo NPI: 1598205718 LIC: DN24491 NPI: 1356732275 LIC: DN21179 Beatriz NPI: 1912359266 LIC: DN21994 NPI: 1376960658 LIC: DN21830 # 022660 # DN13492 Salcines, Damaris # DN22100 Corugedo, Ada Family and Cosmetic NPI: 1891705091 LIC: DN13492 # DN18680 Hernandez-Baco, NPI: 1568814747 LIC: DN22100 Karen Dentistry # DN22991 Santiesteban, Aymara # DN22964 Delgado Rey, Ivette NPI: 1952623993 LIC: DN18680 432 Nw 12Th Ave NPI: 1265826168 LIC: DN22991 NPI: 1679097869 LIC: DN22964 Miami, FL 33128 # DN25053 Perez, Rachel # DN20482 Valdes, Martha # DN24494 Gandara, Maria (305) 387-4954 General Dentist servicing as: NPI: 1194342626 LIC: DN25053 Special Needs: Yes NPI: 1073046603 LIC: DN24494 Endodontics # DN21249 Prieto, Evelyn English, Spanish # DN21579 Garcia, Idalmes NPI: 1649605585 LIC: DN20482 NPI: 1598146755 LIC: DN21249 M-T 9am - 4:30 pm NPI: 1245675107 LIC: DN21579 Th-F 9am - 4:30 pm # DN21179 Reyes Canal, Osmil # 022715 # DN21977 Garrote, Rogelio NPI: 1356732275 LIC: DN21179 # DN25215 Alvarez Fleites, Susel Family and Cosmetic NPI: 1144671470 LIC: DN21977 NPI: 1508476078 LIC: DN25215 # DN13492 Salcines, Damaris Dentistry # DN13322 Gomara, Luis 1437 Ne 1St Ter NPI: 1891705091 LIC: DN13492 # DN23163 Castro, Eileen NPI: 1659381879 LIC: DN13322 NPI: 1518348796 LIC: DN23163 Homestead, FL 33030 # DN23323 Sanchez, Marlie (305) 387-4954 # DN21830 Guerra-Crespa, # DN21994 Cortes Morales, NPI: 1891287462 LIC: DN23323 Special Needs: Yes Beatriz Guillermo # DN22991 Santiesteban, Aymara English, Spanish NPI: 1376960658 LIC: DN21830 NPI: 1912359266 LIC: DN21994 NPI: 1265826168 LIC: DN22991 M-T 9am - 6pm # DN18680 Hernandez-Baco, # DN22100 Corugedo, Ada W-F 9am - 6pm # DN20482 Valdes, Martha Karen NPI: 1568814747 LIC: DN22100 # DN23163 Castro, Eileen General Dentist servicing as: NPI: 1952623993 LIC: DN18680 Endodontics # DN22964 Delgado Rey, Ivette NPI: 1518348796 LIC: DN23163 # DN22276 Pena-Marro, Blanca NPI: 1649605585 LIC: DN20482 NPI: 1679097869 LIC: DN22964 # DN21994 Cortes Morales, NPI: 1043620099 LIC: DN22276 # DN24491 Zerquis Molina, # DN24494 Gandara, Maria Guillermo # DN21249 Prieto, Evelyn Manuel NPI: 1073046603 LIC: DN24494 NPI: 1912359266 LIC: DN21994 NPI: 1598205718 LIC: DN24491 NPI: 1598146755 LIC: DN21249 # DN21579 Garcia, Idalmes # DN22100 Corugedo, Ada # DN21179 Reyes Canal, Osmil NPI: 1568814747 LIC: DN22100 # 009428 NPI: 1245675107 LIC: DN21579 NPI: 1356732275 LIC: DN21179 Family and Cosmetic # DN21977 Garrote, Rogelio # DN22964 Delgado Rey, Ivette # DN13492 Salcines, Damaris Dentistry NPI: 1144671470 LIC: DN21977 NPI: 1679097869 LIC: DN22964 NPI: 1891705091 LIC: DN13492 2900 W. 12Th Ave Ste 27 # DN13322 Gomara, Luis # DN24494 Gandara, Maria # DN23323 Sanchez, Marlie Hialeah, FL 33012 NPI: 1659381879 LIC: DN13322 NPI: 1073046603 LIC: DN24494

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 47 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN21579 Garcia, Idalmes NPI: 1902012669 LIC: DN14996 # DN25258FL Reino Agosto, # 012059 NPI: 1245675107 LIC: DN21579 # DN23490 Chirino, Carlos Tatiana Felicita Marquez Iglesias, NPI: 1184118077 LIC: DN23490 NPI: 1619468519 LIC: DN25258FL # DN21977 Garrote, Rogelio DDS NPI 1144671470 LIC: DN21977 # DN24362 Cortes Fontanet, : 4890 W. 3Rd Ave # 013440 Raisa # DN13322 Gomara, Luis Hialeah, FL 33012 Flores Dental Group (305) 826-0906 NPI: 1124505268 LIC: DN24362 NPI: 1659381879 LIC: DN13322 11890 Sw 8Th Street, Ste #300 Special Needs: Yes # DN23695 Cruz, Yanet # DN21830 Guerra-Crespa, Miami, FL 33184 English, Spanish Beatriz NPI: 1508225376 LIC: DN23695 www.floresdentalgroup.com M-T 9am - 6pm NPI: 1376960658 LIC: DN21830 # DN24480 El Ghannam, Isis (305) 485-0072 W-F 9am - 6pm Special Needs: Yes # DN18680 Hernandez-Baco, NPI: 1316487531 LIC: DN24480 # DN20430 Marquez-Iglesias, English, Spanish Karen # DN25007FL Garcia-Gonzalez, Felicita W-Th 9am - 6pm NPI: 1952623993 LIC: DN18680 NPI: 1740619402 LIC: DN20430 Jheiny # DN117660 Flores, Joan # DN21249 Prieto, Evelyn NPI: 1558988238 LIC: DN25007FL NPI: 1962604488 LIC: DN117660 NPI: 1598146755 LIC: DN21249 # 008287 # DN25214 Herrera Rosales, CERTIFICATIONS: Feoli Dental Dayamis # DN21179 Reyes Canal, Osmil • Inhalation Sedation NPI: 1184233587 LIC: DN25214 NPI: 1356732275 LIC: DN21179 1490 Ne Miami Garden Drive Miami Gardens, FL 33179 # DN22369 Lastra-Perez, Annette # FQHC022784 # DN23323 Sanchez, Marlie www.feolidental.com NPI: 1942745385 LIC: DN22369 Floridental Clinic NPI: 1891287462 LIC: DN23323 (305) 949-5252 # DN25139FL Orozco, Ana 9240 Sw 72Nd Street, Ste 115 # DN22991 Santiesteban, Aymara Special Needs: Yes Miami, FL 33173 English, Spanish, Creoles and NPI: 1114414208 LIC: DN25139FL NPI: 1265826168 LIC: DN22991 (305) 595-0557 Pidgins French-based(other) # DN19848 Ramos, Yilian # DN20482 Valdes, Martha Special Needs: Yes M-T 9am - 5pm General Dentist servicing as: NPI: 1699030205 LIC: DN19848 English, Spanish W-F 9am - 5pm Endodontics # DN25219FL Rodriguez, Yaniris M-T 9am - 6pm # DN18037 Feoli, Carmen NPI: 1649605585 LIC: DN20482 NPI: 1518454636 LIC: DN25219FL W-F 9am - 6pm NPI: 1013199819 LIC: DN18037 # DN22851 Garcia, Lisset # 022417 # DN25070FL Rojas, Viviana NPI: 1487036216 LIC: DN22851 Family Dental Care # 010735 NPI: 1558972562 LIC: DN25070FL Fermin R. Lopez D.D.S PA 3934 Sw 8Th Street, Ste 208 # 015430 # 023118 Coral Gables, FL 33134 Corp Flagler Dental Care LLC Fortune Smiles Dental www.familydentalcoralgables.com 1125 Nw 22Nd Ave 1843 Sw 8Th Street (305) 392-1958 Miami, FL 33125 1199 W. Flagler St, Ste 7 Miami, FL 33135 Special Needs: Yes (305) 649-6112 Miami, FL 33130 Special Needs: No flaglerdentalclinic.com (786) 542-0977 English, Spanish (305) 324-5072 Special Needs: Yes M-T 9am - 5pm English, Spanish Special Needs: Yes English, Spanish W-F 9am - 5pm M-T 8:30 am - 5:30 pm W-F 8:30 am - 5:30 pm English, Spanish M-T 9am - 5pm # DN21526 Alvarez, Ariam W-F 9am - 5pm # DN25220FL Acevedo Jimenez, M-T 9am - 5pm General Dentist servicing as: W-F 9am - 5pm # DN18770 Trujillo, Madelene Endodontics Marcie # DN19770 NPI: 1881835767 LIC: DN18770 NPI: 1962841783 LIC: DN21526 NPI: 1184120875 LIC: DN25220FL Hernandez, Daynet NPI: 1336469121 LIC: DN19770 # DN14996 Beydoun, Miriam # 016316

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 48 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

G.S. Dental Special Needs: Yes # 010098 # 012647 15640 Sw 72Nd St English, Spanish Gateway Dental Health and Cosmetic Dental Miami, FL 33193 M-T 9am - 5pm (305) 200-3404 1050 Nw 14Th Street, 2Nd W-F 9am - 5pm Care Special Needs: Yes Floor, Ste 204/9B # DN22223 Fiffe, Eliseo 4150 Nw 7Th St Ste 103 Miami, FL 33136 Miami, FL 33126 English, Spanish NPI: 1760737480 LIC: DN22223 (305) 646-9222 M-T 9am - 4pm www.gatewaydentalinc.com # DN17433 Martinez, Milton Special Needs: Yes W-F 9am - 4pm (305) 856-2300 Special Needs: Yes General Dentist servicing as: English, Spanish # DN20771 Sague, Gustavo* Endodontics English, Spanish M-T 9am - 4:30 pm NPI: 1699177964 LIC: DN20771 NPI: 1346326972 LIC: DN17433 M-T 9am - 5pm W-F 9am - 4:30 pm W-Th 9am - 5pm # 016124 # 013364 # DN19927 Rodriguez, Gretell # DN18302 Herrera, Victoria Gary Alvo DDS Hammocks Dental Center, NPI: 1154678910 LIC: DN19927 NPI: 1114185550 LIC: DN18302 PA 16600 Ne 8Th Ave # EV931747 Miami, FL 33162 # DN15212 Miranda, Pablo 9280 Hammock Blvd, Ste #102 Hebron Dental, Inc www.garyalvodds.com NPI: 1023036365 LIC: DN15212 Miami, FL 33196 (305) 387-5700 11255 Sw 211 St Ste 205 (305) 944-3441 # DN15477 Perrotti, Steven Special Needs: Yes Special Needs: Yes Miami, FL 33189 NPI: 1144249780 LIC: DN15477 (786) 706-1676 English, Farsi, Spanish English, Spanish # DN22991 Santiesteban, Aymara Special Needs: Yes M-T 7:30 am - 3:30 pm M 12pm - 6pm, T 10am - 4pm NPI: 1265826168 LIC: DN22991 W 3pm - 6pm, Th 10am - 4pm, F English, Spanish # DN7805 Alvo, Gary 10am - 3pm M-T 8am - 3pm NPI: 1518997451 LIC: DN7805 # 022816 # DN21526 Alvarez, Ariam W-F 8am - 3pm Gentle Teeth of Kendall # 006638 General Dentist servicing as: # DN25139FL Orozco, Ana Endodontics Gateway Dental 6670 Sw 117 Ave NPI: 1114414208 LIC: DN25139FL Miami, FL 33183 NPI: 1962841783 LIC: DN21526 2375 Sw 27Th Ave (305) 595-3400 # DN19377 Calderon, Erik # 007623 Miami, FL 33145 Special Needs: Yes Hialeah Dental Associates www.gatewaydentalinc.com NPI: 1942596416 LIC: DN19377 English, Spanish (305) 856-2300 CERTIFICATIONS: 2106 W. 68Th St M-T 8am - 5pm Special Needs: Yes • Inhalation Sedation Hialeah, FL 33016 W 8am - 5pm, Th 11pm - 6pm, F (305) 827-6661 Spanish 8am - 12pm # 011734 Special Needs: No M-T 9am - 5pm # DN24912FL Arguelles, Lauren Happy Teeth Dental, LLC English, Spanish W-Th 9am - 5pm NPI: 1588288609 LIC: DN24912FL 7976 Sw 8Th St M-T 9am - 5pm # DN18302 Herrera, Victoria # DN22652 Perez, Annabel Miami, FL 33144 W-F 9am - 5pm NPI: 1114185550 LIC: DN18302 (305) 266-4544 NPI: 1932639283 LIC: DN22652 # DN13520 Mendez, Antonio # DN15212 Miranda, Pablo Special Needs: Yes NPI: 1659570430 LIC: DN13520 NPI: 1023036365 LIC: DN15212 # 022744 English, Spanish # DN20271 Monzon, Lucrecia M 2pm - 6pm, T 9am - 5pm # DN15477 Perrotti, Steven Great Dental Expressions W-F 9am - 5pm NPI: 1477975399 LIC: DN20271 NPI: 1144249780 LIC: DN15477 Inc 568 Hialeah Drive # DN16431 Rodriguez, Alejandro # DN22991 Santiesteban, Aymara # 013236 Hialeah, FL 33010 NPI: 1942386305 LIC: DN16431 NPI: 1265826168 LIC: DN22991 Hialeah Dental Care, Inc (305) 835-0123

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 49 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

4240 West 16Th Ave M-T 12pm - 8pm 400 Sw 27 Ave Miami, FL 33165 Hialeah, FL 33012 W-Th 12pm - 8pm Miami, FL 33135 (305) 220-0066 (305) 823-1882 # DN19377 Calderon, Erik (305) 456-8046 Special Needs: Yes Special Needs: Yes Special Needs: Yes Spanish NPI: 1942596416 LIC: DN19377 English, Spanish English, Spanish M-T 10am - 5:30 pm CERTIFICATIONS: M-T 9am - 5pm M-T 9am - 6pm • Inhalation Sedation W-F 10am - 5:30 pm W-F 9am - 5pm W-F 9am - 6pm # DN21495 Streett, Rosario # DN14047 Arocha, Josefina # DN21433 Iduate Banobre, # DN20070 Sepulveda, Isabel NPI: 1801230768 LIC: DN21495 NPI: 1952448367 LIC: DN14047 Yolanda NPI: 1790111763 LIC: DN20070 NPI: 1598140618 LIC: DN21433 # 011423 # 019579 # 008271 # DN17094 Rodriguez, Roxana Hialeah Miro Office Corp. Jaime Franco D.M.D, PA Idalmes Perez DDS, PA. NPI: 1336263912 LIC: DN17094 320 W 49 Street 11410 North Kendall Drive Ste 1141 Palm Ave 207 # DN11884 Soler, Rosa Hialeah, FL 33012 www.mirodentalcenter.com Hialeah, FL 33010 Miami, FL 33176 NPI: 1083738652 LIC: DN11884 (305) 685-7494 (305) 888-8555 www.francodentalcare.com Special Needs: No (786) 615-4598 # 010839 Special Needs: Yes English, Spanish Special Needs: No Hialeah Dental Center English, Spanish M-T 9am - 5pm M-T 9am - 6pm English, Spanish 750 East 25Th Street W 9am - 5pm, Th 9am - 4pm, F # DN22185 Gonzalez, Darlen M-T 9am - 5pm Hialeah, FL 33013 W-F 9am - 5pm 9am - 3pm NPI: 1649623034 LIC: DN22185 (305) 694-5400 # DN11650 Miro, Claudio # DN21349 Franco, Jaime Special Needs: Yes # DN17928 Perez, Idalmes NPI: 1417024118 LIC: DN11650 NPI: 1831571744 LIC: DN21349 English, Arabic, Chinese Mandarin, NPI: 1881896306 LIC: DN17928 Portuguese, Romanian, Spanish CERTIFICATIONS: # FQHC018872 M-T 8am - 5pm • Conscious Sedation # 009808 Jessie Trice Community W-Th 8am - 5pm # DN16862 Trujillo, Alexander J.M. Dental Group Inc. Health Center, Inc # DN7077 Benjamin, Paul NPI: 1043231996 LIC: DN16862 1470 Nw 107Th Ave, Ste F-G 217 Nw 15Th Street NPI: 1225057128 LIC: DN7077 CERTIFICATIONS: Miami, FL 33172 Miami, FL 33136 • Conscious Sedation (305) 594-8666 # DN8062 Mulkay, Esteban (305) 637-6400 Special Needs: Yes NPI: 1184784423 LIC: DN8062 # 013560 Special Needs: Yes English, Spanish Homestead Family Dental Creoles and Pidgins # DN19606 Souza, Rodrigo M-T 9am - 5pm English-based(other), English, General Dentist servicing as: Care W-Th 9am - 5pm Spanish Endodontics 809 Ne 4Th Ave # DN20566 Del Castillo, Raymond M-T 8am - 5pm NPI: 1891958146 LIC: DN19606 Homestead, FL 33030 W-F 8am - 5pm (305) 248-3961 NPI: 1609212091 LIC: DN20566 # 007981 Special Needs: Yes # DN22217 Echeverri, Jonathan # DN23140 Feiz, Maria Hialeah Dental Center, PA English, Spanish NPI: 1104371137 LIC: DN22217 NPI: 1932615929 LIC: DN23140 M-T 9am - 5pm 1518 West 49Th Street # DN14451 Hernandez, Norberto # DN12903 George, Deborah Hialeah, FL 33012 # DN19770 Hernandez, Daynet NPI: 1285693267 LIC: DN14451 NPI: 1720149180 LIC: DN12903 www.dentilife.com NPI: 1336469121 LIC: DN19770 # DN21713 Lebron, Vanessa (305) 823-2661 # 008892 NPI: 1619336369 LIC: DN21713 # 012974 Special Needs: Yes Jadent Inc. English, Spanish Honest Dental Service 3945 Sw 92 Ave

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 50 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN25148 Namen Alarcon, Special Needs: Yes NPI: 1659541175 LIC: DN20570 # DN10499 Geno, Jose English Javier # DN19661 Williams, Tosha NPI: 1942496658 LIC: DN10499 NPI: 1255857801 LIC: DN25148 M-T 8am - 5pm NPI: 1609009463 LIC: DN19661 W 8am - 5pm, Th 8am - 6pm, F # 011384 # DN20570 Rameau, Rejane CERTIFICATIONS: 8am - 5pm Joseph S. Gay, D.D.S. NPI: 1659541175 LIC: DN20570 • Inhalation Sedation # DN23140 Feiz, Maria 18063 Nw 27Th Ave # DN19661 Williams, Tosha NPI: 1932615929 LIC: DN23140 # FQHC9797 Miami Gardens, FL 33056 NPI: 1609009463 LIC: DN19661 # DN12903 George, Deborah Jessie Trice Community (305) 625-3747 CERTIFICATIONS: Health Center, Inc. Special Needs: Yes • Inhalation Sedation NPI: 1720149180 LIC: DN12903 5607 Nw 27Th Ave, Ste 2 English # DN21713 Lebron, Vanessa # FQHC015997 Miami, FL 33142 M-T 9am - 5:30 pm NPI: 1619336369 LIC: DN21713 (305) 637-6400 W 11am - 7:30 pm, Th 9am - Jessie Trice Community # DN25148 Namen Alarcon, Special Needs: No 12:30 pm, F 7:30 am - 1:30 pm Health Center, Inc. Javier English, Spanish, Creoles and # DN5710 Gay, Joseph 901 E. 10Th Ave, Bay #39 Pidgins English-based(other), NPI: 1255857801 LIC: DN25148 NPI: 1114084639 LIC: DN5710 Hialeah, FL 33010 French (305) 637-6400 # DN19661 Williams, Tosha M-T 7am - 6pm # 011427 Special Needs: Yes NPI: 1609009463 LIC: DN19661 W-F 7am - 6pm Jossue Alfonso DMD PA English, Spanish, Creoles and CERTIFICATIONS: # DN23140 Feiz, Maria Pidgins French-based(other) • Inhalation Sedation 351 Nw 42Nd Ave, Ste 402 NPI: 1932615929 LIC: DN23140 # DN23140 Feiz, Maria Miami, FL 33126 # FQHC9796 # DN12903 George, Deborah NPI: 1932615929 LIC: DN23140 (305) 642-4142 Jessie Trice Community NPI: 1720149180 LIC: DN12903 Special Needs: Yes # DN12903 George, Deborah Health Center, Inc. English, Spanish # DN21713 Lebron, Vanessa NPI: 1720149180 LIC: DN12903 5361 N.W. 22Nd Ave M-T 9am - 6pm NPI: 1619336369 LIC: DN21713 # DN21713 Lebron, Vanessa Miami, FL 33142 W-F 9am - 6pm # DN25148 Namen Alarcon, NPI: 1619336369 LIC: DN21713 (305) 637-6400 # DN19316 Alfonso, Jossue Special Needs: Yes Javier # DN25148 Namen Alarcon, NPI: 1235423997 LIC: DN19316 English, Spanish, Creoles and NPI: 1255857801 LIC: DN25148 Javier Pidgins English-based(other), # DN20570 Rameau, Rejane # 013606 NPI: 1255857801 LIC: DN25148 French NPI: 1659541175 LIC: DN20570 JR Dental Office INC. # DN20570 Rameau, Rejane M-T 8am - 5pm # DN19661 Williams, Tosha 6847 W. 4Th Ave NPI: 1659541175 LIC: DN20570 W-F 8am - 5pm NPI: 1609009463 LIC: DN19661 Hialeah, FL 33014 # DN19661 Williams, Tosha # DN23140 Feiz, Maria CERTIFICATIONS: (786) 431-5000 NPI: 1609009463 LIC: DN19661 NPI: 1932615929 LIC: DN23140 • Inhalation Sedation Special Needs: Yes CERTIFICATIONS: # DN12903 George, Deborah English, Spanish • Inhalation Sedation NPI: 1720149180 LIC: DN12903 # 007902 M-T 9am - 6pm Jose R. Geno, DMD W-F 9am - 6pm # FQHC016404 # DN21713 Lebron, Vanessa Jessie Trice Community NPI: 1619336369 LIC: DN21713 2200 Sw 16Th Street, Ste 202 # DN20920 De Quesada, Diana Miami, FL 33145 NPI 1992105688 LIC: DN20920 Health Center, Inc. # DN25148 Namen Alarcon, : (305) 854-8707 490 Opa-Locka Blvd Javier # DN12018 Marini, Nohelia Special Needs: No Opa Locka, FL 33054 NPI: 1255857801 LIC: DN25148 NPI: 1568640852 LIC: DN12018 English, Spanish (305) 637-6400 # DN20570 Rameau, Rejane M-T 10am - 5pm

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 51 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Lemus Dental Group English, Spanish English, Spanish # 012608 M-T 9am - 5pm M-T 7am - 2:30 pm 5171 Sw 8Th St Jubidental Services Corp W-F 9am - 5pm W-F 7am - 2:30 pm Miami, FL 33134 299 Alhambra Circle, Ste 202 (305) 567-0236 # DN8736 Costa, Manuel # DN15270 Amundaray, Juan Miami, FL 33134 Special Needs: Yes NPI: 1659495307 LIC: DN8736 NPI: 1306218797 LIC: DN15270 (305) 444-3074 English, Spanish # DN23894 Kinsey, Josefina Special Needs: No M 10am - 7pm, T 9am - 5pm # 009768 NPI: 1043620990 LIC: DN23894 English, Spanish W 10am - 7pm, Th 9am - 5pm, F Mayra Sanchez M-T 8am - 5pm 10am - 3pm # DN15859 Rodriguez, Hernan 5845 W Flagler St W-F 8am - 5pm NPI: 1003950502 LIC: DN15859 # DN20326 Lemus, Isel* Miami, FL 33144 # DN20131 Cotelo-Pardo, NPI: 1033541537 LIC: DN20326 (305) 261-8025 # DN23703 Tellez Armenteros, Yanepsi Special Needs: Yes Ana NPI: 1881986891 LIC: DN20131 # 012095 English, Spanish NPI: 1356828008 LIC: DN23703 Luis M. Santamarina, D.M.D. M-T 9am - 4:30 pm # 019686 # FQHC015504 330 Sw 27Th Ave Ste 602 Th-F 9am - 4:30 pm Kendall Dental & Implant Miami, FL 33135 # DN9618 Sanchez, Mayra Miami Beach Community Center (305) 644-3464 NPI: 1558680439 LIC: DN9618 Health Center, Inc. 13055 Sw 42Nd St Ste #206 Special Needs: Yes 11645 Biscayne Blvd. Ste Miami, FL 33175 Spanish, English, German # 018131 401-403 kendalldentalimplant.com M-T 9am - 12pm Med Dental Associates North Miami, FL 33181 (305) 846-9669 (305) 538-8835 # DN8610 Santamarina, Luis 7200 Nw 7Th St. #333 Special Needs: Yes Special Needs: Yes NPI: 1427157320 LIC: DN8610 Miami, FL 33126 English, Spanish English, Spanish, Creoles and (305) 264-0063 M-T 8am - 5pm Pidgins English-based(other) # 018466 Special Needs: No W 8am - 5pm, Th 8am - 8pm, F M-T 7:30 am - 4pm Maira Morales DDS LLC 8am - 5pm English, Spanish W-F 7:30 am - 4pm 5232 W. Flagler St M-T 9am - 5pm # DN18984 Garcia, Delio # DN15270 Amundaray, Juan Miami, FL 33134 W-F 9am - 5pm NPI: 1790006823 LIC: DN18984 NPI: 1306218797 LIC: DN15270 (305) 442-0331 # DN24338 Gonzalez, Yusdely # DN23894 Kinsey, Josefina # 018216 Special Needs: No NPI: 1841846482 LIC: DN24338 English, Spanish NPI: 1043620990 LIC: DN23894 Kindly Dental # DN20905 Rodriguez Castro, M-T 9am - 5pm # DN15859 Rodriguez, Hernan 18652 Nw 67Th Ave, Ste 27 Miriam W-F 9am - 5pm Hialeah, FL 33015 NPI: 1992051700 LIC: DN20905 NPI: 1003950502 LIC: DN15859 # DN21552 Morales, Maira DN23703 www.nsdclinic.com # DN17094 Rodriguez, Roxana # Tellez Armenteros, (305) 474-0400 General Dentist servicing as: Ana Endodontics NPI: 1336263912 LIC: DN17094 Special Needs: No NPI: 1356828008 LIC: DN23703 NPI: 1023202496 LIC: DN21552 English, Spanish # FQHC012099 M-T 9am - 4pm # 006579 # 008355 Miami Beach Community Th-F 9am - 4pm Miami International Mall Manuel E. Costa, DDS Health Center, Inc. # DN20258 Garcia Lopez, Dorgis* 710 Alton Rd Dental 791 E. 48Th St NPI: 1992147326 LIC: DN20258 Miami Beach, FL 33139 1455 Nw 107Th Ave, Ste 584 Hialeah, FL 33013 Doral, FL 33172 (305) 538-8835 (305) 769-0252 # 012706 Special Needs: Yes (305) 597-8787 Special Needs: Yes

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 52 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Special Needs: Yes General Dentist servicing as: NPI: 1437700937 LIC: 24529 English, Spanish Russian, English, Spanish Pediatric Dentistry M-T 9am - 5pm # DN23402 Montenegro, Christian M-T 11am - 8pm NPI: 1619407566 LIC: DN22714 NPI: 1144714445 LIC: DN23402 # DN20996 Peralta, Johnny* W-F 11am - 8pm # DN24375FL Gaton Molina, Sarah NPI: 1396179701 LIC: DN20996 # DN23652 Ospina, Luz # DN25272 Alameri, Mustafa NPI: 1538713979 LIC: DN24375FL General Dentist servicing as: # 011787 NPI: 1912516626 LIC: DN25272 # DN20710 Gonzalez, Kely Oral Surgery Miami Smile Studio # DN22246 Antezana, Mauricio NPI: 1952717027 LIC: DN20710 NPI: 1881181501 LIC: DN23652 Corporation General Dentist servicing as: # DN20151 Gonzalez, Kenia # DN22018 Pansuriya, Pediatric Dentistry 27325 S Dixie Hwy General Dentist servicing as: Dharmendra NPI: 1063876399 LIC: DN22246 Homestead, FL 33032 Pediatric Dentistry General Dentist servicing as: (786) 601-2644 # DN21079 Arnedo, Johanna NPI: 1578902813 LIC: DN20151 Pediatric Dentistry Special Needs: Yes General Dentist servicing as: NPI: 1932645736 LIC: DN22018 # DN22242 Guerra, Vannette English, Spanish Pediatric Dentistry NPI: 1598184327 LIC: DN22242 # DN22652 Perez, Annabel M-T 9am - 5pm NPI: 1104213909 LIC: DN21079 NPI: 1932639283 LIC: DN22652 W-F 9am - 5pm CERTIFICATIONS: # DN17335FL Guilarte, Rhona • Inhalation Sedation NPI: 1619956323 LIC: DN17335FL # DN22702 Pham, Quynhnhu # DN18258 Hossain, Marta NPI: 1609323948 LIC: DN22702 NPI: 1699912865 LIC: DN18258 # DN17412 Atkinson, William # DN23847 Khan, Adiba General Dentist servicing as: NPI: 1649638172 LIC: DN23847 # DN23021 Riboul, Sandrine # 021944 Pediatric Dentistry NPI: 1609227057 LIC: DN23021 # DN22197 Khatib, Adel Migdalia I Seijas DDS, PA NPI: 1942360862 LIC: DN17412 CERTIFICATIONS: General Dentist servicing as: CERTIFICATIONS: • Inhalation Sedation 1169 W. 35Th Street Endodontics • Inhalation Sedation Hialeah, FL 33012 NPI: 1235582503 LIC: DN22197 # DN23007 Rivera, Lina # DN21645 Baez Henry, (305) 819-0820 NPI: 1760908743 LIC: DN23007 Carlianette # DN16377 Krasnov, Rostislav Special Needs: Yes # DN20475 Santiago, Germaine NPI: 1235594961 LIC: DN21645 NPI: 1942267935 LIC: DN16377 English, Spanish NPI: 1922341460 LIC: DN20475 M-T 1pm - 6:30 pm # DN17123 Bravo, Raquel # DN24131 Krupnov, Vera # DN23257 Shippee, Rebecca # DN13282 Seijas, Migdalia NPI: 1538312525 LIC: DN17123 NPI: 1386202984 LIC: DN24131 NPI: 1841778164 LIC: DN23257 NPI: 1548677271 LIC: DN13282 # DN21812 Cabrera, Rene # DN20101 Licina, Zeljka NPI: 1013263292 LIC: DN20101 # DN24155 Trivedi, Sujay General Dentist servicing as: # 011422 Pediatric Dentistry NPI: 1356909352 LIC: DN24155 # DN24055 Lodhi, Hafsa Miro Kendall Dental Office NPI: 1518313675 LIC: DN21812 NPI: 1588023584 LIC: DN24055 # DN21066 Uzunova-Dimova, 13550 Sw 88 St, Ste 100 # DN7894 Cullen, William Kalina # DN23637 Lopez, Catherine Miami, FL 33186 General Dentist servicing as: General Dentist servicing as: NPI: 1558841890 LIC: DN23637 mirodentalcenter.com Pediatric Dentistry Pediatric Dentistry (305) 273-4334 NPI: 1013110535 LIC: DN7894 # DN23728 Lopez, Elssy NPI: 1245540947 LIC: DN21066 Special Needs: Yes CERTIFICATIONS: NPI: 1215439757 LIC: DN23728 # CHC022739 English, Spanish • Inhalation Sedation # DN15694 Luong, Timothy Miami Lakes Cosmetic M-T 9am - 5pm # DN24313FL Evans, Mana NPI: 1740302629 LIC: DN15694 W-Th 9am - 5pm Dentistry NPI: 1750818712 LIC: DN24313FL # DN19470 Maniglia, Marielba 6600 Cow Pen Road # DN11650 Miro, Claudio # DN22714 Fornes-Ferrero, NPI: 1063793644 LIC: DN19470 Hialeah, FL 33014 NPI: 1417024118 LIC: DN11650 Patricia # 24529 Moini, Marshall (305) 823-7521 CERTIFICATIONS: Special Needs: Yes • Conscious 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 53 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN16786 Miro, Kiara Special Needs: Yes NPI: 1740756063 LIC: DN23756 (305) 557-6968 English, Spanish Special Needs: Yes NPI: 1427078625 LIC: DN16786 # DN24501 Jaime Garriga, Yanet W 9am - 6pm, Th 10am - 6pm, F English, Spanish # DN16862 NPI: 1134605843 LIC: DN24501 Trujillo, Alexander 9am - 4pm M-T 9am - 6pm NPI: 1043231996 LIC: DN16862 # DN10538 Johnson, Robert # DN21526 Alvarez, Ariam # DN12604 Mendigutia, Jose CERTIFICATIONS: NPI: 1275600686 LIC: DN10538 General Dentist servicing as: NPI: 1396876991 LIC: DN12604 • Conscious Sedation Endodontics # DN11108 Lang, Tomas NPI: 1962841783 LIC: DN21526 # 012860 NPI: 1386758886 LIC: DN11108 # 009811 Norberto J. Hernandez MJ Dental Office # EV927550 # DN17815 Lopez De Victoria, Millied D.D.S., P.A. 2360 W. 68Th St Ste 124 My Smile Center at Miller 1235 Sw 27Th Ave Hialeah, FL 33016 NPI: 1467405423 LIC: DN17815 Inc Miami, FL 33135 (305) 825-7447 # DN13131 Miranda, Alejandra 13878 Sw 56Th St (305) 642-7796 Special Needs: Yes Miami, FL 33175 NPI: 1558328823 LIC: DN13131 Special Needs: No English, Spanish (305) 908-3144 # DN20570 Rameau, Rejane English, Spanish M-T 9am - 4:30 pm Special Needs: No M-T 10am - 5:30 pm W-Th 9am - 4:30 pm NPI: 1659541175 LIC: DN20570 English, Spanish W-F 10am - 5:30 pm # DN21842 Alvarado, Yailen W-F 9am - 4pm # DN14396 Watson-Hamilton, Sheri # DN14451 Hernandez, Norberto NPI: 1700235363 LIC: DN21842 # DN21526 Alvarez, Ariam NPI: 1053580639 LIC: DN14396 NPI: 1285693267 LIC: DN14451 # DN22548FL Dopazo Alonso, General Dentist servicing as: Endodontics Dhunia # 011548 # 013413 NPI: 1962841783 LIC: DN21526 NPI: 1467982629 LIC: DN22548FL New Dental Care Corp Omar Perez-Murguia, DDS, # DN19789 Gil Araujo, Eduardo # FQHC7695 1250 Sw 27Th Ave Ste 203 PA 9835 Sw 40Th Street NPI: 1841553112 LIC: DN19789 Naranja Health Center Miami, FL 33135 (305) 649-9443 Miami, FL 33165 13805 Sw 264Th Street # EV956090 Special Needs: Yes (305) 552-6446 Homestead, FL 33032 MSG Dental LLC English, Spanish Special Needs: Yes www.chisouthfl.org M 8am - 4pm, T 9am - 5pm English, Spanish 7801 Nw 95Th St Ste 2 (305) 258-8066 W 11am - 6pm, Th 9am - 5pm, F M-T 8am - 5pm Hialeah, FL 33016 Special Needs: Yes W-Th 8am - 5pm (786) 542-8954 8am - 4pm English, Chinese Mandarin, # DN15727 Special Needs: Yes Creoles and Pidgins # DN11884 Soler, Rosa Perez-Murguia, Omar English, Spanish English-based(other), French, NPI: 1083738652 LIC: DN11884 NPI: 1033210216 LIC: DN15727 M-T 9am - 5:30 pm Polish, Spanish # DN23694 Yglesias Ruiz, Erick W-F 9am - 5:30 pm W-F 8:30 am - 6pm # 021740 General Dentist servicing as: Ortholine Family Dentistry # DN23323 Sanchez, Marlie # DN20512 Cala-Morales, Angela Endodontics NPI: 1891287462 LIC: DN23323 NPI: 1376823203 LIC: DN20512 NPI: 1427534239 LIC: DN23694 3934 Sw 8Th Street, Ste 305 Coral Gables, FL 33134 # DN19206 Campbell, Lisa CERTIFICATIONS: # 013978 • Inhalation Sedation (305) 967-8882 NPI: 1659594497 LIC: DN19206 My Smile Center Special Needs: No # DN11945 Chin- Thompson, # 013438 English, Spanish 12800 Sw 8Th St Angella New Family Dentistry Miami, FL 33184 # DN12529 Martinez, Jose NPI: 1215150909 LIC: DN11945 www.mysmilecentermiami.com 1410 W. 68Th St NPI: 1780798926 LIC: DN12529 (786) 332-3176 # DN23756 Fernandez, Malena Hialeah, FL 33014

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 54 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

2851 W. 68Th St. Bay 12 NPI: 1376079939 LIC: DN22785 Perkadent # 019161 Hialeah, FL 33018 # DN24236 Soca, Yanisleidy 1878 Sw 57Th Ave Palmetto Dental Studio, Inc. payadental.com NPI: 1124689955 LIC: DN24236 Miami, FL 33155 (786) 502-4467 7306 W 20 Ave (305) 262-9299 Special Needs: Yes Hialeah, FL 33016 # 008306 Special Needs: Yes English, Spanish www.thepalmettodentalstudio.c Pedro Alvarez DDS and English, Spanish om M 9am - 5pm, T 8am - 6pm Associates, PA M 8am - 3pm, T 9:30 am - 5:30 (786) 747-4763 W 9am - 5pm, Th 8am - 6pm, F 610 E. 4Th Ave pm Special Needs: Yes 9am - 5pm W-F 9:30 am - 5:30 pm Hialeah, FL 33010 English, Spanish # DN21221 Paya, Anabel (305) 885-5026 # DN20428 Revoredo, Karim M-T 9am - 5pm NPI: 1609256700 LIC: DN21221 Special Needs: Yes NPI: 1366730384 LIC: DN20428 W-F 9am - 5pm # DN22785 Rielo, Miguel English, Spanish # DN22568 Benavides, Alina NPI: 1376079939 LIC: DN22785 M-T 1pm - 6pm # 018714 NPI: 1629507470 LIC: DN22568 Pro Dental Center West # DN24236 Soca, Yanisleidy # DN11762 Alvarez, Pedro Hialeah # 014229 NPI: 1124689955 LIC: DN24236 NPI: 1235271255 LIC: DN11762 400 West 65 Street Pan American Dental P.A. & # 018945 # 018202 Hialeah, FL 33012 Assoc. www.ProDentalCenters.com Paya Dental and Associates Pedro Quesada DDS PA 2060 Sw 27Th Ave (305) 827-0434 742 W. 49Th St Miami, FL 33145 2143 Nw 7Th Street Special Needs: Yes Miami, FL 33125 Hialeah, FL 33012 (305) 444-4430 English, Spanish (305) 541-5103 (786) 534-9216 Special Needs: Yes M-T 9am - 5pm Special Needs: Yes Special Needs: Yes English, Spanish W-F 9am - 5pm M-T 9:30 am - 6pm English, Spanish English, Spanish # DN17100 Corrales-Iglesias, W-F 9:30 am - 6pm M-T 9am - 5pm M 9am - 6pm, T 11am - 5pm Luisa W-F 9am - 5pm W 9am - 6pm, Th 11am - 5pm, F # DN20998 Gutierrez, Marlen 9am - 6pm NPI: 1861546277 LIC: DN17100 # DN21221 Paya, Anabel NPI: 1740686948 LIC: DN20998 # DN21528 Quezada, Pedro NPI: 1609256700 LIC: DN21221 # 008238 # 014230 NPI: 1164898177 LIC: DN21528 # DN22785 Rielo, Miguel Professional Dental Group, Pan American Dental P.A. & NPI: 1376079939 LIC: DN22785 # 021744 PA Assoc. Perez Dental Group Inc 10122 West Flagler Street 1124 W. 29Th St # EV698969 Miami, FL 33174 7801 Coral Way, Ste 122 Hialeah, FL 33012 Paya Dental Center (305) 226-3386 Miami, FL 33155 (305) 885-7767 Special Needs: Yes 6641 S Dixie Hwy Unit A (786) 360-3694 Special Needs: Yes English, Spanish Miami, FL 33143 Special Needs: Yes English, Spanish M-T 9am - 6pm (305) 667-0306 English, Spanish M-T 9:30 am - 6pm Special Needs: Yes W-F 9am - 6pm M 9am - 5pm, T 10am - 6pm W-F 9:30 am - 6pm English, Spanish W 9am - 5pm, Th 10am - 6pm, F # DN14823 Baro, Rosemarie # DN20998 Gutierrez, Marlen M-T 9am - 5pm 9am - 5pm NPI: 1396758165 LIC: DN14823 NPI: 1740686948 LIC: DN20998 W-F 9am - 5pm # DN21498 Perez Carmona, Alba # DN21221 Paya, Anabel # 008232 # 015408 NPI: 1548636244 LIC: DN21498 NPI: 1609256700 LIC: DN21221 Professional Dental Paya Dental # 015911 Solutions # DN22785 Rielo, 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 55 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

7900 Nw 27Th Ave, Ste 275 Special Needs: No NPI: 1689700221 LIC: DN14344 English, Spanish Miami, FL 33147 English, Spanish M 9am - 5pm, T 11am - 7pm (305) 693-7988 M-T 9am - 6pm # 016142 W 9am - 5pm, Th 10am - 7pm, F Special Needs: Yes W-F 9am - 6pm Rosario G. Molina, DMD 9am - 5pm English, Spanish # DN21812 Cabrera, Rene 1909 Sw 27Th Ave # DN22962 Ruiz Rodriguez, Julian M-T 9am - 4pm General Dentist servicing as: Miami, FL 33145 NPI: 1447619820 LIC: DN22962 W-F 9am - 4pm Pediatric Dentistry (305) 685-5133 # DN16699 Diaz, Gertrudis NPI: 1518313675 LIC: DN21812 Special Needs: Yes # 011966 NPI: 1932248044 LIC: DN16699 English, Spanish Salazar Dental # 017261 M-T 9am - 6:30 pm # DN17350 Ramos, Luis 8346 Sw 8 St Renata Kleiner-Pastoriza W-Th 9am - 6:30 pm Miami, FL 33144 NPI: 1114000304 LIC: DN17350 DDS PA # DN9515 Molina, Rosario (305) 269-0208 9654 Sw 72 St # 017415 NPI: 1912231549 LIC: DN9515 Special Needs: Yes Miami, FL 33173 Quality Professional English, Spanish (305) 598-3704 # 007730 M-T 9am - 5pm Dentistry Corp Special Needs: Yes W-F 9am - 5pm 5040 Nw 7Th St Ste 632 Rosario Molina, DMD English, Spanish, Polish Miami, FL 33126 4835 East 4Th Ave, Ste # A # DN18913 Salazar, Manuel M 10am - 6pm, T 9am - 6pm www.qualitydentatist Miami.com Hialeah, FL 33013 NPI: 1699097261 LIC: DN18913 W 9am - 6pm, Th 9am - 5pm, F (305) 342-2020 (305) 685-5133 9am - 2pm Special Needs: No Special Needs: Yes # 012093 # DN10551 Kleiner, Renata English, Spanish English, Spanish Salvador Rosales DDS P.A. NPI: 1700902400 LIC: DN10551 M-T 9am - 5pm M-T 9am - 6pm 8150 Sw 8Th St Ste 206 CERTIFICATIONS: W-F 9am - 5pm # DN9515 Molina, Rosario Miami, FL 33144 • Inhalation Sedation # DN11609 Herdocia, Filiberto NPI: 1912231549 LIC: DN9515 (305) 261-5556 NPI: 1750788030 LIC: DN11609 # 008233 Special Needs: No Rolando J. Molina, DDS, PA # 008237 English, Spanish # 009717 Rosemarie Baro, DDS M 9am - 6:30 pm, T 9am - 6pm 45 Nw 8Th Street, Sutie #101 Th-F 9am - 6:30 pm Ramos Dental Associates Homestead, FL 33030 1449 West Flagler Street 4564 West 12Th Ave (305) 242-5223 Miami, FL 33135 # DN12058 Rosales, Salvador Hialeah, FL 33012 Special Needs: No (305) 649-3500 NPI: 1457441511 LIC: DN12058 (305) 558-2446 English, Spanish Special Needs: Yes Special Needs: Yes English, Spanish # 009227 # DN14344 Molina, Rolando English, Spanish M-T 9:30 am - 6pm Sandy Dental, Inc NPI: 1689700221 LIC: DN14344 M-T 10am - 4pm W-F 9:30 am - 6pm 8000 W. Flagler St. Ste 204 W-F 10am - 4pm # 008234 # DN14823 Baro, Rosemarie Miami, FL 33144 # DN17350 Ramos, Luis Rolando J. Molina, DDS, PA NPI: 1396758165 LIC: DN14823 www.sanderdental.net NPI 1114000304 LIC: DN17350 (305) 266-5222 : 5991 Sw 8Th Street # 022337 Special Needs: No Miami, FL 33144 # 022133 English, Spanish (305) 262-0505 Ruiz Family Dentistry M-T 9am - 5pm RC Dental Special Needs: Yes 10550 Nw 77 Court, Ste 220 12305 Sw 112 Street English, Spanish Hialeah, FL 33016 # DN15375 Borges, Jorge Miami, FL 33186 (786) 401-7566 NPI: 1144361916 LIC: DN15375 # DN14344 Molina, Rolando (305) 596-0322 Special Needs: Yes 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 56 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

• Inhalation Sedation Miami, FL 33157 English, Spanish Special Needs: Yes (786) 701-8246 M-T 9am - 6pm English, Spanish # EV819031 Special Needs: Yes W-F 9am - 6pm M-T 11am - 8pm Seven Dental of Hialeah, Inc English, Spanish # DN19465 De Sousa, Marvina W-F 11am - 8pm 1935 W 60Th St M-T 8am - 8pm S 12pm - 4pm, Su 12 pm - 4 pm NPI: 1841572963 LIC: DN19465 Hialeah, FL 33012 W-F 8am - 8pm # DN22246 Antezana, Mauricio # DN19470 (305) 821-3344 Maniglia, Marielba # DN20128FL Pfundheller, Dustin General Dentist servicing as: Special Needs: Yes NPI: 1063793644 LIC: DN19470 NPI: 1538673207 LIC: DN20128FL Pediatric Dentistry English, Spanish NPI: 1063876399 LIC: DN22246 # 021604 M 9am - 5pm, T 8am - 12pm # 006611 # DN21079 Arnedo, Johanna W 8am - 12pm, Th 1pm - 9pm, F South Dental at Forest Smile Perfect Dental Health General Dentist servicing as: 4pm - 9pm Lakes-Kendall Square Inc Center Pediatric Dentistry # DN22857 Traviesas Herrera, 16705 Sw 95Th Street 580 E. 49Th Street NPI: 1104213909 LIC: DN21079 Eladio Miami, FL 33196 Hialeah, FL 33013 CERTIFICATIONS: www.southdental.org NPI 1992187876 LIC: DN22857 : www.easthialehdental.com • Inhalation Sedation (786) 329-5909 (305) 557-6711 # DN17412 Atkinson, William # 014843 Special Needs: No Special Needs: Yes General Dentist servicing as: Simple Smiles LLC English, Spanish English, Spanish Pediatric Dentistry M-T 9am - 5:30 pm 18400 Nw 75Th Place, Ste 121 M-T 9am - 7pm NPI: 1942360862 LIC: DN17412 W-F 9am - 5:30 pm Miami, FL 33015 W-F 9am - 7pm CERTIFICATIONS: (305) 381-5412 # DN14672 Tobon-Angel, Elias # DN13355 Cardenas, Elio • Inhalation Sedation Special Needs: Yes NPI: 1689794885 LIC: DN14672 NPI: 1134287659 LIC: DN13355 # DN17123 Bravo, Raquel English, Spanish # 023126 NPI: 1538312525 LIC: DN17123 M 9am - 7pm, T 9am - 6pm # 016312 # DN21812 W-Th 9am - 5pm South Florida Dental Care Cabrera, Rene Smile Perfect Dental Health General Dentist servicing as: # DN17310 Lleo, Pedro 922 East 25Th Street Center II Pediatric Dentistry Hialeah, FL 33013 NPI: 1942306394 LIC: DN17310 1075 E. 4Th Ave NPI: 1518313675 LIC: DN21812 (786) 542-9700 Hialeah, FL 33010 # 013979 Special Needs: No # DN7894 Cullen, William (305) 557-6712 English, Spanish General Dentist servicing as: Smile Design Special Needs: Yes M-T 9am - 5pm Pediatric Dentistry 2915 Nw 7Th St English, Spanish W-F 9am - 5pm NPI: 1013110535 LIC: DN7894 Miami, FL 33125 M-T 9am - 6pm CERTIFICATIONS: # DN25214 Herrera Rosales, (305) 846-9082 W-F 9am - 6pm • Inhalation Sedation Special Needs: Yes Dayamis # DN13355 Cardenas, Elio # DN24313FL Evans, Mana English, Spanish NPI: 1184233587 LIC: DN25214 NPI: 1134287659 LIC: DN13355 NPI: 1750818712 LIC: DN24313FL M 9am - 4pm, T 9am - 6pm # DN19530 Swanson, Wendy # DN20710 Gonzalez, Kely W-Th 9am - 4pm # 017138 NPI: 1790085819 LIC: DN19530 NPI: 1952717027 LIC: DN20710 # DN19487 Perez, Diley Smile Solutions Dental # 009753 NPI: 1780962092 LIC: DN19487 Group # DN17335FL Guilarte, Rhona 8200 W. 33Rd Ave Ste 5 Southland Mall Dental NPI: 1619956323 LIC: DN17335FL # EV794146 Hialeah, FL 33018 20505 S. Dixie Hwy Ste 1683 # DN23847 Khan, Adiba Smile Mission, Pllc (305) 640-5501 Miami, FL 33189 NPI: 1649638172 LIC: DN23847 9900 Sw 168Th St Special Needs: No (305) 232-3737

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 57 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN22197 Khatib, Adel English, Russian, Spanish NPI: 1942267935 LIC: DN16377 W-F 9am - 5pm M-T 11am - 8pm General Dentist servicing as: # DN18770 Trujillo, Madelene # DN12018 Marini, Nohelia Endodontics W-F 11am - 8pm NPI: 1881835767 LIC: DN18770 NPI: 1568640852 LIC: DN12018 NPI: 1235582503 LIC: DN22197 # DN16377 Krasnov, Rostislav # DN16377 Krasnov, Rostislav NPI: 1942267935 LIC: DN16377 # 022892 # 008295

NPI: 1942267935 LIC: DN16377 # DN18770 Trujillo, Madelene Sunny Dental Care Susana Lizaso, DDS # DN24131 Krupnov, Vera NPI: 1881835767 LIC: DN18770 9766 Sw 24Th Street, Ste 8 4999 West 8Th Ave, Ste 28 Hialeah, FL 33012 NPI: 1386202984 LIC: DN24131 Miami, FL 33165 # 016775 (305) 995-0542 (305) 556-6055 # DN20101 Licina, Zeljka Stomatcare Special Needs: No Special Needs: Yes NPI: 1013263292 LIC: DN20101 English, Spanish English, Spanish 1602 Ne 163Rd St. # DN24055 Lodhi, Hafsa M-T 9am - 5pm North Miami Beach, FL 33162 M 10am - 5pm, T 9am - 5pm W-F 9am - 5pm NPI: 1588023584 LIC: DN24055 (305) 330-6382 W 9am - 5pm, Th 10pm - 5pm, F 9am - 2pm # DN19470 Maniglia, Marielba Special Needs: Yes # DN14242 Lizaso, Susana # DN21542 Herrera Casas, NPI: 1063793644 LIC: DN19470 English, Russian, Spanish NPI: 1174602429 LIC: DN14242 M-T 8am - 4pm Sunilda # 24529 Moini, Marshall W-F 8am - 4pm NPI: 1447673629 LIC: DN21542 # 022225 NPI: 1437700937 LIC: 24529 # DN16377 Krasnov, Rostislav Sweet Smile Dental # DN23652 Ospina, Luz # 023021 NPI: 1942267935 LIC: DN16377 16010 Nw 57Th Ave, Ste 130 General Dentist servicing as: Sunset Center Dental Miami Lakes, FL 33014 Oral Surgery # 016776 Service (786) 536-9411 NPI: 1881181501 LIC: DN23652 10300 Sw 72 Sunset Drive, Ste Stomatcare Special Needs: No # DN23021 Riboul, Sandrine 280 English, Spanish 522 E. 25Th St Miami, FL 33173 NPI: 1609227057 LIC: DN23021 M-T 9am - 5pm Hialeah, FL 33013 www.sunsetcenterdentalservices CERTIFICATIONS: W-F 9am - 5pm (305) 330-6351 .com • Inhalation Sedation Special Needs: Yes (786) 534-7314 # DN17960 Gonzalez, Susana # DN23007 Rivera, Lina English, Russian, Spanish Special Needs: No NPI: 1457654824 LIC: DN17960 NPI: 1760908743 LIC: DN23007 M-T 8am - 4pm English, Spanish # 013762 # DN20475 Santiago, Germaine W-F 8am - 4pm M-T 9am - 5pm Sylvia Santana P.A. NPI: 1922341460 LIC: DN20475 # DN16377 Krasnov, Rostislav Th-F 9am - 5pm # DN19530 Swanson, Wendy 11300 Nw 87Th Ct # 166 # DN21066 Uzunova-Dimova, NPI: 1942267935 LIC: DN16377 Hialeah, FL 33018 Kalina NPI: 1790085819 LIC: DN19530 # 018551 www.biltmoredental.com General Dentist servicing as: (305) 364-9322 Pediatric Dentistry Stomatcare # 018201 Special Needs: Yes NPI: 1245540947 LIC: DN21066 10457 Sw 40Th St Superior Dental English, Spanish Miami, FL 33165 148 Hialeah Drive M-T 9am - 6pm # 016689 (305) 602-1638 Hialeah, FL 33010 W-F 9am - 6pm Stomatcare Special Needs: Yes www.superiordentaldds.com # DN19864 Santana-Mentrasti, 15516 Sw 88Th Street English, Russian, Spanish (786) 360-6262 Miami, FL 33196 M-T 11am - 8pm Special Needs: Yes Sylvia (305) 330-6359 W-F 11am - 8pm English, Spanish NPI: 1679820344 LIC: DN19864 Special Needs: Yes # DN16377 Krasnov, Rostislav M-T 9am - 5pm # 008296

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 58 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

The Family Dental Care North Miami Beach, FL 33162 Hialeah, FL 33012 W 9am - 5pm, Th 8am - 4pm, F Center (305) 940-9888 (305) 826-8980 9am - 3pm 646 W Palm Dr, Ste 200 Special Needs: Yes Special Needs: No # DN18983 Batista, Virginia Florida City, FL 33034 English, Spanish, Mandarin English, Spanish NPI: 1760702575 LIC: DN18983 (305) 242-1200 M-T 9am - 5:30 pm M-T 9am - 5pm # DN18627 Perez, Alina Special Needs: No W-F 9am - 5:30 pm W-F 9am - 5pm NPI: 1649408469 LIC: DN18627 English # DN15966 Elperin, Alexei # DN22857 Traviesas Herrera, # DN16616 Villar, Tania M-T 9am - 5pm NPI: 1295930063 LIC: DN15966 Eladio NPI: 1245320068 LIC: DN16616 W-F 9am - 5pm NPI: 1992187876 LIC: DN22857 # DN18608 Haratz, Zina # DN14560 De la Cruz, Alejandro NPI 1972747608 LIC: DN18608 # 019072 : # 021734 NPI: 1013152016 LIC: DN14560 # DN12723 Hui, Tin Traviesas Dental Care Vassallo Dental Office P.A # DN13073 Gonzalez Sr., Carlos 8782 Sw 8Th St. Ste A NPI: 1952408619 LIC: DN12723 7933 Nw 2Nd Street NPI: 1790959963 LIC: DN13073 Miami, FL 33174 # DN20869 Kiani, Kamran Miami, FL 33126 (305) 552-5340 # 021453 NPI: 1699175729 LIC: DN20869 (305) 261-5251 Special Needs: N/A Special Needs: Yes The Tooth Place # DN23454FL Nguyen, Michelle English, Spanish English, Spanish General Dentist servicing as: 8 Palms Plz # DN11722 Vasallo, Francisco # DN22857 Traviesas Herrera, Homestead, FL 33030 Endodontics NPI: 1730207077 LIC: DN11722 (305) 245-7974 NPI: 1033603733 LIC: DN23454FL Eladio CERTIFICATIONS: NPI: 1992187876 LIC: DN22857 Special Needs: Yes # FQHC7696 English, Spanish • Inhalation Sedation # EV683703 West Perrine Health Center M-T 9am - 6pm # 008258 18255 Homestead Ave W-F 9am - 6pm United Dental Care, P.A. Tin Wai Hui, DMD, PA Miami, FL 33157 3009 E 4Th Ave # DN13216 Alvarado, Adolfo 12651 S. Dixie Hwy, #400 Hialeah, FL 33013 (305) 234-7676 NPI: 1881782993 LIC: DN13216 Special Needs: Yes Miami, FL 33156 (305) 691-1616 (305) 595-4548 English, Chinese Mandarin, # 011963 Special Needs: No Creoles and Pidgins Special Needs: Yes English, Spanish Thomas Dental Associates English-based(other), French, English, Spanish, Cantonese, M-T 9am - 6pm Polish, Spanish 14050 Nw 7Th Ave French, Mandarin # DN25215 Alvarez Fleites, Susel M 10:30 am - 7pm, T 8:30 am - Miami, FL 33168 M 9am - 6pm, T 9:30 am - 6pm 5pm [email protected] W-F 9:30 am - 6pm NPI: 1508476078 LIC: DN25215 Th-F 8:30 am - 5pm (305) 688-7989 # DN15384 Cheng, Xiaofang # DN11884 Soler, Rosa Special Needs: Yes # DN20512 Cala-Morales, Angela NPI: 1104945807 LIC: DN15384 NPI: 1083738652 LIC: DN11884 English, Spanish, Creoles and NPI: 1376823203 LIC: DN20512 # DN12723 Hui, Tin Pidgins English-based(other), # 007535 # DN19206 Campbell, Lisa Haitian; Haitian Creole NPI: 1952408619 LIC: DN12723 Unlimited Dental Care NPI: 1659594497 LIC: DN19206 M-T 12pm - 5pm # DN20869 Kiani, Kamran 11498 Quail Roost Dr # DN11945 Chin- Thompson, # DN9652 Krakauer, Thomas NPI: 1699175729 LIC: DN20869 Miami, FL 33157 Angella NPI: 1093841009 LIC: DN9652 (305) 232-4469 NPI: 1215150909 LIC: DN11945 # 018214 Special Needs: Yes # 008256 # DN23756 Fernandez, Malena Traviesas Dental Care English, Spanish Tin Wai Hui NPI: 1740756063 LIC: DN23756 4301 Palm Ave, Ste F M-T 9am - 5pm 16209 Ne 13Th Ave

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 59 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN24501 Jaime Garriga, Yanet General Dentist servicing as: NPI: 1649638172 LIC: DN23847 # DN23021 Riboul, Sandrine* Pediatric Dentistry NPI: 1134605843 LIC: DN24501 # DN22197 Khatib, Adel* NPI: 1609227057 LIC: DN23021 NPI: 1942360862 LIC: DN17412 # DN10538 Johnson, Robert General Dentist servicing as: CERTIFICATIONS: CERTIFICATIONS: Endodontics • Inhalation Sedation NPI: 1275600686 LIC: DN10538 • Inhalation Sedation NPI: 1235582503 LIC: DN22197 # DN23007 Rivera, Lina* # DN11108 Lang, Tomas # DN21645 Baez Henry, # DN16377 Krasnov, Rostislav* NPI: 1760908743 LIC: DN23007 NPI: 1386758886 LIC: DN11108 Carlianette* NPI: 1942267935 LIC: DN16377 # DN20475 Santiago, Germaine* # DN17815 Lopez De Victoria, NPI: 1235594961 LIC: DN21645 # DN24131 Krupnov, Vera* NPI: 1922341460 LIC: DN20475 Millied # DN17123 Bravo, Raquel* NPI: 1386202984 LIC: DN24131 NPI: 1467405423 LIC: DN17815 NPI: 1538312525 LIC: DN17123 # DN23257 Shippee, Rebecca* # DN20101 Licina, Zeljka* NPI: 1841778164 LIC: DN23257 # DN13131 Miranda, Alejandra # DN21812 Cabrera, Rene* NPI: 1558328823 LIC: DN13131 General Dentist servicing as: NPI: 1013263292 LIC: DN20101 # DN24155 Trivedi, Sujay* Pediatric Dentistry # DN20570 Rameau, Rejane # DN24055 Lodhi, Hafsa* NPI: 1356909352 LIC: DN24155 NPI: 1518313675 LIC: DN21812 NPI: 1659541175 LIC: DN20570 NPI: 1588023584 LIC: DN24055 # DN21066 Uzunova-Dimova, # DN7894 Cullen, William* Kalina* # DN14396 Watson-Hamilton, # DN23637 Lopez, Catherine* General Dentist servicing as: General Dentist servicing as: Sheri NPI: 1558841890 LIC: DN23637 Pediatric Dentistry Pediatric Dentistry NPI: 1053580639 LIC: DN14396 # DN23728 Lopez, Elssy* NPI: 1013110535 LIC: DN7894 NPI: 1245540947 LIC: DN21066 CERTIFICATIONS: NPI: 1215439757 LIC: DN23728 # 006580 • Inhalation Sedation # DN15694 Luong, Timothy* # 009582 Westland Mall Dental # DN24313FL Evans, Mana* NPI: 1740302629 LIC: DN15694 World Dental Care 1665 W. 49Th St, Ste 1484 NPI: 1750818712 LIC: DN24313FL 1370 East 4 Ave Hialeah, FL 33012 # DN19470 Maniglia, Marielba* Hialeah, FL 33010 (305) 828-7779 # DN22714 Fornes-Ferrero, NPI: 1063793644 LIC: DN19470 (305) 888-1458 Special Needs: Yes Patricia* # 24529 Moini, Marshall* Special Needs: No General Dentist servicing as: Russian, English, Spanish NPI: 1437700937 LIC: 24529 Pediatric Dentistry English, Spanish M-T 11am - 8pm NPI: 1619407566 LIC: DN22714 # DN23402 Montenegro, M-T 9am - 5pm W-F 11am - 8pm Christian* W-F 9am - 5pm S 12pm - 4pm, Su 12 pm - 4 pm # DN24375FL Gaton Molina, NPI: 1144714445 LIC: DN23402 # DN22851 Garcia, Lisset # DN25272 Alameri, Mustafa* Sarah* # DN23652 Ospina, Luz* NPI: 1487036216 LIC: DN22851 NPI: 1912516626 LIC: DN25272 NPI: 1538713979 LIC: DN24375FL General Dentist servicing as: # DN21793 Rivera, Britzy # DN22246 # DN20710 Gonzalez, Kely* Antezana, Mauricio* Oral Surgery NPI: 1952717027 LIC: DN20710 NPI: 1386060440 LIC: DN21793 General Dentist servicing as: NPI: 1881181501 LIC: DN23652 Pediatric Dentistry # DN20151 Gonzalez, Kenia* # DN11884 Soler, Rosa # DN22018 Pansuriya, NPI: 1063876399 LIC: DN22246 General Dentist servicing as: NPI: 1083738652 LIC: DN11884 Dharmendra* # DN21079 Arnedo, Johanna* Pediatric Dentistry General Dentist servicing as: # DN22857 Traviesas Herrera, NPI: 1578902813 LIC: DN20151 General Dentist servicing as: Pediatric Dentistry Eladio Pediatric Dentistry # DN22242 Guerra, Vannette* NPI: 1932645736 LIC: DN22018 NPI: 1992187876 LIC: DN22857 NPI: 1104213909 LIC: DN21079 NPI: 1598184327 LIC: DN22242 # DN22652 Perez, Annabel* CERTIFICATIONS: # 008225 # DN17335FL Guilarte, Rhona* NPI: 1932639283 LIC: DN22652 • Inhalation Sedation Zoraida T. Sanchez NPI: 1619956323 LIC: DN17335FL # DN17412 Atkinson, William* # DN22702 Pham, Quynhnhu* 1619 North East 8 Street # DN23847 Khan, Adiba* NPI: 1609323948 LIC: DN22702

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 60 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Homestead, FL 33030 Westland Mall Dental • General Anesthesia S 12pm - 4pm, Su 12 pm - 4 pm (305) 247-9292 # DN13591 Nielsen, Pamela 1665 W. 49Th St, Ste 1484 # 007768 Special Needs: Yes Hialeah, FL 33012 NPI: 1124118245 LIC: DN13591 Regina H. Saenz, DDS, PA English, Spanish (305) 828-7779 M-T 9am - 6pm Special Needs: Yes 950 North Krome Ave, Ste 204 # 006580 Homestead, FL 33030 W-F 9am - 6pm Russian, English, Spanish Westland Mall Dental (305) 245-6633 # DN14420 Barrera, Martha* M-T 11am - 8pm 1665 W. 49Th St, Ste 1484 Special Needs: Yes NPI: 1790023562 LIC: DN14420 W-F 11am - 8pm Hialeah, FL 33012 English, Spanish S 12pm - 4pm, Su 12 pm - 4 pm (305) 828-7779 # DN17191FL Sanchez, Yoel* M-T 8:30 am - 5pm # DN13421 Gittess, Robert* Special Needs: Yes NPI: 1144591751 LIC: DN17191FL W-F 8:30 am - 5pm NPI: 1922137058 LIC: DN13421 Russian, English, Spanish # DN16063 Sanchez, Zoradia* # DN15235 Saenz, Regina M-T 11am - 8pm NPI: 1093824096 LIC: DN16063 ORAL SURGEON NPI: 1417047218 LIC: DN15235 W-F 11am - 8pm CERTIFICATIONS: S 12pm - 4pm, Su 12 pm - 4 pm ENDODONTICS • Inhalation Sedation # 021756 # DN13591 Nielsen, Pamela* • General Anesthesia Ambiance Surgical Arts NPI 1124118245 LIC: DN13591 # 006579 : Center PERIODONTICS Miami International Mall # DN23099 Rodriguez, Iveliss* 8501 Sw 124Th Ave, Ste 208 Dental NPI: 1962971200 LIC: DN23099 Miami, FL 33183 # 006579 1455 Nw 107Th Ave, Ste 584 (786) 377-4344 Miami International Mall MONROE COUNTY Doral, FL 33172 Special Needs: No (305) 597-8787 Dental English, Spanish DENTIST Special Needs: Yes 1455 Nw 107Th Ave, Ste 584 M-T 7:30 am - 4pm Russian, English, Spanish Doral, FL 33172 W 7:30 am - 4pm, Th 9:30 am - # FQHC7692 M-T 11am - 8pm (305) 597-8787 6pm, F 7:30 am - 4pm Marathon Health Center W-F 11am - 8pm Special Needs: Yes # DN21773 Hines, Jerri Russian, English, Spanish 2805 Overseas Highway # DN13421 Gittess, Robert NPI: 1861552770 LIC: DN21773 M-T 11am - 8pm Marathon, FL 33050 NPI: 1922137058 LIC: DN13421 CERTIFICATIONS: W-F 11am - 8pm www.chisouthfl.org • General Anesthesia (305) 743-4000 # 009753 # DN13591 Nielsen, Pamela Special Needs: Yes Southland Mall Dental # 009284 NPI: 1124118245 LIC: DN13591 English, Chinese Mandarin, Regina H. Saenz 20505 S. Dixie Hwy Ste 1683 # DN23099 Rodriguez, Iveliss Creoles and Pidgins Miami, FL 33189 3695 W. 4Th Ave NPI: 1962971200 LIC: DN23099 English-based(other), French, (305) 232-3737 Hialeah, FL 33012 Polish, Spanish Special Needs: Yes (786) 536-2767 # 009753 W 8:30 am - 5pm, Th 8:30 am - English, Spanish Special Needs: Yes Southland Mall Dental 7pm, F 8:30 am - 5pm M-T 11am - 8pm Spanish 20505 S. Dixie Hwy Ste 1683 # DN20512 Cala-Morales, Angela W-F 11am - 8pm M-T 8:30 am - 5:30 pm Miami, FL 33189 NPI: 1376823203 LIC: DN20512 S 12pm - 4pm, Su 12 pm - 4 pm W-F 8:30 am - 5:30 pm (305) 232-3737 # DN11945 Chin- Thompson, # DN13421 Gittess, Robert # DN15235 Saenz, Regina Special Needs: Yes Angella NPI: 1922137058 LIC: DN13421 NPI: 1417047218 LIC: DN15235 English, Spanish NPI: 1215150909 LIC: DN11945 CERTIFICATIONS: M-T 11am - 8pm # DN23756 Fernandez, Malena # 006580 • Inhalation Sedation W-F 11am - 8pm NPI: 1740756063 LIC: DN23756

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 61 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN24501 Jaime Garriga, Yanet DOH - Nassau County Health # DN14565 Dudley, Alexander # DN14000 Naryshkin, George NPI: 1134605843 LIC: DN24501 Department General Dentist servicing as: NPI: 1730395773 LIC: DN14000 37203 Pecan St NPI: 1518975499 LIC: DN14565 # DN10538 Johnson, Robert # DN23400 Pham, Emily Hilliard, FL 32046 NPI: 1275600686 LIC: DN10538 # DN24185 Durham, Dominique NPI: 1851947568 LIC: DN23400 (904) 320-6007 General Dentist servicing as: # DN11108 Lang, Tomas Special Needs: Yes # DN13771 Sanchez, Armando NPI: 1053972257 LIC: DN24185 NPI: 1386758886 LIC: DN11108 English, Vietnamese NPI: 1992764930 LIC: DN13771 # DN24876FL Soekirman, Lauren # DN17815 Lopez De Victoria, # DN14307 Gupton, Frank # DN13207 Zayas, Alida General Dentist servicing as: Millied NPI: 1962411876 LIC: DN14307 NPI: 1639148968 LIC: DN13207 NPI: 1467405423 LIC: DN17815 CERTIFICATIONS: NPI: 1508489238 LIC: DN24876FL • Inhalation Sedation ORANGE COUNTY # DN13131 Miranda, Alejandra ORAL SURGEON NPI: 1558328823 LIC: DN13131 # CHC9678 DENTIST # DN14396 Watson-Hamilton, DOH - Nassau County Health # EV519781 Sheri Department Howard E. Fisher # 011595 NPI: 1053580639 LIC: DN14396 86207 Felmor Rd 1755 Lewis Turner Blvd A.K.M.W. Islam, BDS, P.A. Yulee, FL 32097 Fort Walton Beach, FL 32547 1925 E. Michigan St Ste 101 # FQHC011413 (904) 875-6090 (850) 863-1182 Orlando, FL 32806 RHN Dental Group - Key Special Needs: Yes Special Needs: Yes DRAKISLAM.COM West English, Spanish English, Spanish (407) 896-6336 3706 N. Roosevelt Blvd, Ste E # DN14307 Gupton, Frank M-T 10am - 4pm Special Needs: No Key West, FL 33040 NPI: 1962411876 LIC: DN14307 # DN7089 Fisher, Howard English, Arabic, Bengali, Spanish www.rhnmc.org M-T 8am - 5pm CERTIFICATIONS: NPI: 1689643769 LIC: DN7089 (305) 517-6613 • Inhalation Sedation W-F 8am - 5pm Special Needs: Yes OKEECHOBEE COUNTY # DN11823 Islam, A.K.M.W. English, Spanish, Creoles and OKALOOSA COUNTY General Dentist servicing as: Pidgins English-based(other) DENTIST Endodontics M-T 8am - 5pm DENTIST NPI: 1225048796 LIC: DN11823 W-F 8am - 5pm # FQHC020247 # FQHC013738 # 30734 Atanda, Olamide Florida Community Health # FQHC7785 Crestview Dental Center NPI: 1245528686 LIC: 30734 Centers, Inc. Apopka Dental (Community 800 Hospital Dr. # DN23214 Rodriguez Ramos, 2015 Us Highway 441 Health Ctr) Oscar Crestview, FL 32539 Okeechobee, FL 34972 210 E. Seventh Street www.northfloridamedicalcenters. NPI: 1831406982 LIC: DN23214 www.fchcinc.org Apopka, FL 32703 org (863) 763-1951 www.chcfl.org # DN17019 Sander, Michael (850) 423-4603 Special Needs: Yes (407) 905-8827 General Dentist servicing as: Special Needs: Yes English, Spanish Special Needs: Yes Endodontics English, Spanish M 8am - 6pm, T 8am - 5pm English, Spanish, Creoles and NPI: 1558878744 LIC: DN17019 M-T 8am - 5pm W-Th 8am - 5pm Pidgins French-based(other) W-F 8am - 5pm M 8am - 6pm, T 8am - 7pm NASSAU COUNTY # DN20720 Blackwood, Alberto # DN21203 Chou, Victor W-Th 8am - 5pm NPI: 1487057303 LIC: DN20720 DENTIST General Dentist servicing as: # DN12870 Browning, Lisa # DN13607 Morales, Carlos NPI: 1558741249 LIC: DN21203 General Dentist servicing as: # CHC9677 NPI: 1457310559 LIC: DN13607 Pediatric 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 62 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1457570103 LIC: DN12870 NPI: 1386618544 LIC: DN11858 # DN15961 Dhamija, Jugnu (407) 322-8645 Special Needs: Yes # DN15276 Chen, May CERTIFICATIONS: NPI: 1568781227 LIC: DN15961 • Inhalation Sedation English, Spanish, Vietnamese NPI: 1609096502 LIC: DN15276 # DN12387 Poveromo, Marc # 010439 M-T 8am - 6pm # DN16298 Chery, Pascale General Dentist servicing as: Avalon Dental Group W-Th 8am - 6pm General Dentist servicing as: Pediatric Dentistry 3804 E. Colonial Drive # DN21596 Nagib, Marie Claire Pediatric Dentistry NPI: 1780745141 LIC: DN12387 Orlando, FL 32803 NPI: 1225414907 LIC: DN21596 NPI: 1235138439 LIC: DN16298 CERTIFICATIONS: (407) 898-3800 # DN13946 Estrada, Luis • Inhalation Sedation Special Needs: Yes # FQHC7971 General Dentist servicing as: # DN22449 Stewart, Elizabeth English, Spanish, Vietnamese Community Health Centers, Pediatric Dentistry General Dentist servicing as: M-T 9am - 5pm Inc. NPI: 1245258565 LIC: DN13946 Pediatric Dentistry W-F 9am - 5pm 13275 W. Colonial Drive CERTIFICATIONS: NPI: 1891155271 LIC: DN22449 # DN22748 Winter Garden, FL 34787 • Inhalation Sedation Chen, Lona* www.chcfl.org # DN10172 Stewart, Gregg NPI: 1508387465 LIC: DN22748 # DN19362 Gonzalez, Patricia General Dentist servicing as: (407) 905-8827 # DN17997 Van, Jennie* NPI: 1760633739 LIC: DN19362 Pediatric Dentistry Special Needs: Yes General Dentist servicing as: CERTIFICATIONS: NPI: 1619977733 LIC: DN10172 English, Spanish Endodontics • Inhalation Sedation M 8am - 6pm, T 8am - 6:30 pm # DN16458 Teodoru, Catalin NPI: 1831399344 LIC: DN17997 # DN21870FL Gordon, Toni-Anne W-Th 8am - 5pm General Dentist servicing as: # DN17986 Van, Nga* NPI: 1376077040 LIC: DN21870FL Pediatric Dentistry # DN12870 Browning, Lisa General Dentist servicing as: # DN8556 Kiernan, Loyd NPI: 1407854847 LIC: DN16458 General Dentist servicing as: Endodontics NPI: 1578502332 LIC: DN8556 Pediatric Dentistry # DN13300 Velez-Leon, Waleska NPI: 1023217163 LIC: DN17986 NPI: 1457570103 LIC: DN12870 # DN15208 Mcdowell-Travis, General Dentist servicing as: Janet Pediatric Dentistry # FQHC9097 # DN15276 Chen, May General Dentist servicing as: NPI: 1316040819 LIC: DN13300 Central Florida Family NPI: 1609096502 LIC: DN15276 Pediatric Dentistry # DN23384 Vo, Tina Health Center, Inc. # DN16298 Chery, Pascale NPI: 1992072540 LIC: DN15208 NPI: 1548754849 LIC: DN23384 5730 Lake Underhill Road General Dentist servicing as: Orlando, FL 32807 Pediatric Dentistry # DN19016 Munguba, Bozena # DN18247 Wray, Roger mytruehealth.org NPI: 1235138439 LIC: DN16298 NPI: 1043530462 LIC: DN19016 General Dentist servicing as: (407) 322-8645 # DN18690 Nguyen, Kathleen Pediatric Dentistry # DN13946 Estrada, Luis Special Needs: Yes General Dentist servicing as: NPI: 1528026630 LIC: DN18247 General Dentist servicing as: English, Spanish Pediatric Dentistry Pediatric Dentistry # 009736 M-T 8am - 6pm NPI: 1013143544 LIC: DN18690 NPI: 1245258565 LIC: DN13946 W-Th 8am - 6pm CERTIFICATIONS: Artistic Smiles of Orlando CERTIFICATIONS: • Inhalation Sedation 3592 Aloma Ave, Ste 1 # DN21596 Nagib, Marie Claire • Inhalation Sedation # DN15582 Nicola, Rania* Winter Park, FL 32792 NPI: 1225414907 LIC: DN21596 # DN19362 Gonzalez, Patricia General Dentist servicing as: www.artisticsmilesoforlando.com NPI: 1760633739 LIC: DN19362 # FQHC9816 Pediatric Dentistry (407) 678-7744 CERTIFICATIONS: NPI: 1033186986 LIC: DN15582 Special Needs: Yes Central Florida Family • Inhalation Sedation English, Spanish, Hindi Health Center, Inc. # DN11858 Palomeque, Theresa # DN21870FL Gordon, Toni-Anne M-T 8am - 4pm 11881-A E Colonial Dr General Dentist servicing as: NPI: 1376077040 LIC: DN21870FL W-Th 8am - 4pm Orlando, FL 32826 Pediatric Dentistry # DN8556 Kiernan, Loyd www.mytruehealth.org

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 63 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1578502332 LIC: DN8556 # DN23384 Vo, Tina* # DN17407 Bello, Andres # DN15208 Mcdowell-Travis,

# DN15208 Mcdowell-Travis, NPI: 1548754849 LIC: DN23384 NPI: 1487615019 LIC: DN17407 Janet General Dentist servicing as: Janet # DN18247 Wray, Roger # DN10829 Russo, Richard Pediatric Dentistry General Dentist servicing as: General Dentist servicing as: NPI: 1063553774 LIC: DN10829 NPI: 1992072540 LIC: DN15208 Pediatric Dentistry Pediatric Dentistry NPI: 1992072540 LIC: DN15208 NPI: 1528026630 LIC: DN18247 # FQHC7786 # DN19016 Munguba, Bozena # DN19016 Munguba, Bozena Eatonville Dental NPI: 1043530462 LIC: DN19016 # 007776 NPI: 1043530462 LIC: DN19016 (Community Health Center) # DN18690 Nguyen, Kathleen Conway Dental Care # DN18690 Nguyen, Kathleen 7900 Forest City Road General Dentist servicing as: 3862 Curry Ford Rd. Orlando, FL 32810 Pediatric Dentistry General Dentist servicing as: Pediatric Dentistry Orlando, FL 32806 www.chcfl.org NPI: 1013143544 LIC: DN18690 NPI: 1013143544 LIC: DN18690 (407) 894-2048 (407) 905-8827 CERTIFICATIONS: Special Needs: No Special Needs: Yes • Inhalation Sedation CERTIFICATIONS: • Inhalation Sedation English, Spanish English, Spanish # DN15582 Nicola, Rania M-T 8am - 5pm M 8am - 6pm, T 8am - 6:30 pm # DN11858 Palomeque, Theresa General Dentist servicing as: W-Th 8am - 5pm W-Th 8am - 5pm Pediatric Dentistry General Dentist servicing as: Pediatric Dentistry # DN10824 Qureshi, Naghman* # DN12870 Browning, Lisa NPI: 1033186986 LIC: DN15582 NPI: 1386618544 LIC: DN11858 NPI: 1558407619 LIC: DN10824 General Dentist servicing as: # DN11858 Palomeque, Theresa CERTIFICATIONS: Pediatric Dentistry General Dentist servicing as: • Inhalation Sedation # CHC10238 NPI: 1457570103 LIC: DN12870 Pediatric Dentistry # DN12387 Poveromo, Marc DOH - Orange County Health # DN15276 Chen, May NPI: 1386618544 LIC: DN11858 General Dentist servicing as: Department NPI: 1609096502 LIC: DN15276 CERTIFICATIONS: Pediatric Dentistry 832 West Central Blvd • Inhalation Sedation # DN16298 Chery, Pascale NPI: 1780745141 LIC: DN12387 Orlando, FL 32805 # DN12387 Poveromo, Marc General Dentist servicing as: CERTIFICATIONS: (407) 723-4039 General Dentist servicing as: Pediatric Dentistry • Inhalation Sedation Special Needs: Yes Pediatric Dentistry NPI: 1235138439 LIC: DN16298 # DN22449 Stewart, Elizabeth Spanish, English NPI: 1780745141 LIC: DN12387 # DN13946 Estrada, Luis General Dentist servicing as: # DN17407 Bello, Andres* CERTIFICATIONS: General Dentist servicing as: • Inhalation Sedation Pediatric Dentistry NPI: 1487615019 LIC: DN17407 Pediatric Dentistry NPI: 1891155271 LIC: DN22449 # DN22449 Stewart, Elizabeth # DN10829 Russo, Richard* NPI: 1245258565 LIC: DN13946 # DN10172 Stewart, Gregg General Dentist servicing as: NPI: 1063553774 LIC: DN10829 CERTIFICATIONS: Pediatric Dentistry General Dentist servicing as: • Inhalation Sedation Pediatric Dentistry NPI: 1891155271 LIC: DN22449 # CHC10239 # DN19362 Gonzalez, Patricia NPI: 1619977733 LIC: DN10172 # DN10172 Stewart, Gregg DOH - Orange County Health NPI: 1760633739 LIC: DN19362 General Dentist servicing as: # DN16458 Teodoru, Catalin Department CERTIFICATIONS: Pediatric Dentistry General Dentist servicing as: 5449 S. Semoran Blvd, Ste 19B • Inhalation Sedation Pediatric Dentistry NPI: 1619977733 LIC: DN10172 Orlando, FL 32822 # DN21870FL Gordon, Toni-Anne NPI: 1407854847 LIC: DN16458 (407) 723-5264 # DN16458 Teodoru, Catalin NPI: 1376077040 LIC: DN21870FL # DN13300 Velez-Leon, Waleska Special Needs: Yes General Dentist servicing as: # DN8556 Kiernan, Loyd Pediatric Dentistry General Dentist servicing as: English, Spanish Pediatric Dentistry M-T 8am - 5pm NPI: 1578502332 LIC: DN8556 NPI: 1407854847 LIC: DN16458 NPI: 1316040819 LIC: DN13300 W-F 8am - 5pm # DN13300 Velez-Leon, Waleska

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 64 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

General Dentist servicing as: # DN16298 Chery, Pascale General Dentist servicing as: # DN23622 Akyuz, Magda Pediatric Dentistry Pediatric Dentistry General Dentist servicing as: NPI: 1699264424 LIC: DN23622 NPI: 1316040819 LIC: DN13300 Pediatric Dentistry NPI: 1780745141 LIC: DN12387 # DN25135FL Hoffman, Francis # DN23384 Vo, Tina NPI: 1235138439 LIC: DN16298 CERTIFICATIONS: • Inhalation Sedation NPI: 1891290003 LIC: DN25135FL NPI: 1548754849 LIC: DN23384 # DN13946 Estrada, Luis # DN22449 Stewart, Elizabeth # DN19935 Keskar, Meghan # DN18247 Wray, Roger General Dentist servicing as: General Dentist servicing as: Pediatric Dentistry NPI: 1417205790 LIC: DN19935 General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry NPI: 1245258565 LIC: DN13946 NPI: 1891155271 LIC: DN22449 # FQHC517949 NPI: 1528026630 LIC: DN18247 CERTIFICATIONS: • Inhalation Sedation # DN10172 Stewart, Gregg Orange Blossom Family # 020282-HOSP1 # DN19362 Gonzalez, Patricia General Dentist servicing as: Health Pediatric Dentistry 4426 Old Winter Garden Rd Florida Dental Team LLC (By NPI: 1760633739 LIC: DN19362 NPI: 1619977733 LIC: DN10172 Orlando, FL 32811 Referral Only) CERTIFICATIONS: (407) 428-5751 1000 Woodcock Rd, Ste 120 • Inhalation Sedation # DN16458 Teodoru, Catalin Special Needs: Yes Orlando, FL 32803 # DN21870FL Gordon, Toni-Anne General Dentist servicing as: English, Spanish, French, Tagalog (407) 792-1968 Pediatric Dentistry NPI: 1376077040 LIC: DN21870FL Special Needs: Yes NPI: 1407854847 LIC: DN16458 M-T 8am - 5pm # DN8556 Kiernan, Loyd W-F 8am - 5pm Spanish, English # DN13300 Velez-Leon, Waleska NPI: 1578502332 LIC: DN8556 M-T 8am - 4pm General Dentist servicing as: # DN19583 Acosta, Edwin W-F 8am - 4pm # DN15208 Mcdowell-Travis, Pediatric Dentistry General Dentist servicing as: Endodontics # DN14994 Berk, Lars* Janet NPI: 1316040819 LIC: DN13300 General Dentist servicing as: NPI: 1578729711 LIC: DN19583 NPI: 1336251487 LIC: DN14994 # DN23384 Vo, Tina* Pediatric Dentistry # DN23622 Akyuz, Magda NPI: 1548754849 LIC: DN23384 # DN19359 Dorsey, Cassandra* NPI: 1992072540 LIC: DN15208 NPI: 1699264424 LIC: DN23622 NPI: 1629363940 LIC: DN19359 # DN18247 Wray, Roger # DN19016 Munguba, Bozena General Dentist servicing as: # DN25135FL Hoffman, Francis NPI: 1043530462 LIC: DN19016 # FQHC7970 Pediatric Dentistry NPI: 1891290003 LIC: DN25135FL # DN18690 Nguyen, Kathleen Lake Ellenor Dental NPI: 1528026630 LIC: DN18247 # DN19935 Keskar, Meghan General Dentist servicing as: (Community Health Ctr) NPI: 1417205790 LIC: DN19935 6101 Lake Ellenor Dr. Ste 106 Pediatric Dentistry # FQHC011105 Orlando, FL 32809 NPI: 1013143544 LIC: DN18690 Orange Blossom Family # FQHC021664 www.chcfl.org CERTIFICATIONS: Health Orange Blossom Family • Inhalation Sedation (407) 905-8827 232 North Orange Blossom Trail Health - Dental Clinic Special Needs: No # DN15582 Nicola, Rania* Orlando, FL 32805 3100 Evans Trojan Way General Dentist servicing as: (407) 428-5751 English Middle (1100-1500), Orlando, FL 32808 Spanish Pediatric Dentistry Special Needs: Yes (407) 428-5751 M-T 8am - 5pm NPI: 1033186986 LIC: DN15582 English, Spanish, Creoles and Special Needs: Yes W-Th 8am - 5pm Pidgins English-based(other) # DN11858 Palomeque, Theresa English, Spanish, Creoles and M-T 7:45 am - 4:30 pm # DN12870 Browning, Lisa General Dentist servicing as: Pidgins English-based(other) W-F 7:45 am - 4:30 pm General Dentist servicing as: Pediatric Dentistry # DN19583 Acosta, Edwin* Pediatric Dentistry NPI: 1386618544 LIC: DN11858 # DN19583 Acosta, Edwin General Dentist servicing as: NPI 1457570103 LIC: DN12870 : CERTIFICATIONS: General Dentist servicing as: Endodontics Endodontics # DN15276 Chen, May • Inhalation Sedation NPI: 1578729711 LIC: DN19583 NPI: 1578729711 LIC: DN19583 NPI: 1609096502 LIC: DN15276 # DN12387 Poveromo, Marc

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 65 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23622 Akyuz, Magda* # DN12870 Browning, Lisa • Inhalation Sedation General Dentist servicing as: NPI: 1699264424 LIC: DN23622 General Dentist servicing as: # DN12387 Poveromo, Marc Endodontics Pediatric Dentistry General Dentist servicing as: NPI: 1275592040 LIC: DN16372 # DN25135FL Hoffman, Francis* NPI: 1457570103 LIC: DN12870 Pediatric Dentistry CERTIFICATIONS: NPI: 1891290003 LIC: DN25135FL • Inhalation Sedation # DN15276 Chen, May NPI: 1780745141 LIC: DN12387 # DN19935 Keskar, Meghan* CERTIFICATIONS: NPI: 1609096502 LIC: DN15276 ORAL SURGEON NPI: 1417205790 LIC: DN19935 • Inhalation Sedation # DN16298 Chery, Pascale # DN22449 Stewart, Elizabeth # FQHC019163 General Dentist servicing as: # 018735 General Dentist servicing as: Pediatric Dentistry Central Florida Institute of Orange Blossom Pediatrics Pediatric Dentistry NPI: 1235138439 LIC: DN16298 Oral Surgery & Dental 701 W Livingston St Bldg 800 NPI: 1891155271 LIC: DN22449 # DN13946 Estrada, Luis Implants Orlando, FL 32805 # DN10172 Stewart, Gregg General Dentist servicing as: 320 N. Edinburg Drive Ste A (407) 428-5751 General Dentist servicing as: Pediatric Dentistry Winter Park, FL 32792 Special Needs: Yes Pediatric Dentistry NPI: 1245258565 LIC: DN13946 www.centralfloridaos.com English, Spanish, Chinese (T), NPI: 1619977733 LIC: DN10172 Creoles and Pidgins CERTIFICATIONS: (407) 951-6554 # DN16458 Teodoru, Catalin English-based(other), Hindi, • Inhalation Sedation Special Needs: Yes General Dentist servicing as: Tagalog # DN19362 Gonzalez, Patricia English, Spanish M-T 8am - 5pm Pediatric Dentistry NPI: 1760633739 LIC: DN19362 M-T 7am - 4:30 pm W-F 8am - 5pm NPI: 1407854847 LIC: DN16458 W-F 7am - 4:30 pm CERTIFICATIONS: # DN19583 Acosta, Edwin* • Inhalation Sedation # DN13300 Velez-Leon, Waleska # DN18163FL Aves, Renato General Dentist servicing as: General Dentist servicing as: # DN21870FL Gordon, Toni-Anne NPI: 1336322650 LIC: DN18163FL Endodontics Pediatric Dentistry NPI: 1376077040 LIC: DN21870FL CERTIFICATIONS: NPI: 1316040819 LIC: DN13300 NPI: 1578729711 LIC: DN19583 • Inhalation Sedation # DN8556 Kiernan, Loyd # DN23622 Akyuz, Magda* # DN23384 Vo, Tina* • General Anesthesia NPI: 1578502332 LIC: DN8556 NPI: 1699264424 LIC: DN23622 NPI: 1548754849 LIC: DN23384 # DN19378 Samaniego, Juan # DN15208 Mcdowell-Travis, NPI: 1467692129 LIC: DN19378 # DN25135FL Hoffman, Francis* # DN18247 Wray, Roger Janet General Dentist servicing as: CERTIFICATIONS: NPI: 1891290003 LIC: DN25135FL General Dentist servicing as: Pediatric Dentistry • Inhalation Sedation # DN19935 Pediatric Dentistry • General Anesthesia Keskar, Meghan* NPI: 1528026630 LIC: DN18247 NPI: 1417205790 LIC: DN19935 NPI: 1992072540 LIC: DN15208 # DN16473 Walcott, Sean # DN19016 Munguba, Bozena # 021739 NPI: 1841250743 LIC: DN16473 # FQHC7784 NPI: 1043530462 LIC: DN19016 Yes! Dental Associates of CERTIFICATIONS: Pine Hills Dental • General Anesthesia # DN18690 Nguyen, Kathleen Florida (Community Health Center) 12554 S. John Young Parkway, General Dentist servicing as: PEDIATRIC DENTISTRY 840 Mercy Drive Pediatric Dentistry Ste 104 Orlando, FL 32810 NPI: 1013143544 LIC: DN18690 Orlando, FL 32837 www.chcfl.org # 020282-HOSP1 CERTIFICATIONS: (407) 847-8000 Florida Dental Team LLC (By (407) 905-8827 • Inhalation Sedation Special Needs: Yes Special Needs: Yes English, Spanish Referral Only) # DN11858 Palomeque, Theresa English, Spanish, Creoles and M-T 7am - 3pm 1000 Woodcock Rd, Ste 120 General Dentist servicing as: Pidgins French-based(other) Th-F 7am - 3pm Orlando, FL 32803 Pediatric Dentistry M 8am - 6pm, T 8am - 6:30 pm (407) 792-1968 NPI: 1386618544 LIC: DN11858 # DN16372 Katsur, Justin W-Th 8am - 5pm Special Needs: Yes 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 66 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Spanish, English NPI: 1669602876 LIC: DN20019 # DN21572 Carballo, Mauro # DN22999 Reyes, Christina M-T 8am - 4pm CERTIFICATIONS: NPI: 1508200635 LIC: DN21572 NPI: 1679931000 LIC: DN22999 W-F 8am - 4pm • Pediatric Conscious Sedation # DN12668 Congote, Luis # DN11150 Reyes, Miguel • Inhalation Sedation # DN17078 Aliotti, Michelle* • Conscious Sedation General Dentist servicing as: NPI: 1407948482 LIC: DN11150 NPI: 1124142062 LIC: DN17078 Pediatric Dentistry # DN21646 Theogene, Dorothy* # DN24069 Rodriguez Gonzalez, # DN18989 Chuong, Christopher* NPI: 1679774426 LIC: DN12668 NPI: 1699055004 LIC: DN21646 David General Dentist servicing as: # DN23695 Cruz, Yanet CERTIFICATIONS: NPI: 1548798960 LIC: DN24069 Endodontics • Inhalation Sedation NPI: 1508225376 LIC: DN23695 # DN19389 Sanchez, Arnaldo NPI: 1992017156 LIC: DN18989 • Conscious Sedation # DN24481 Defaus Fernandez, CERTIFICATIONS: • Board Certification NPI: 1831486844 LIC: DN19389 Beatriz • Pediatric Conscious Sedation # DN25322 Wang, Dixin* # DN24107 Serhan Lopez, Nayef • Inhalation Sedation NPI: 1023558087 LIC: DN24481 NPI: 1023490026 LIC: DN25322 NPI: 1184282550 LIC: DN24107 • Board Certification # DN23705 Diaz Valle, Orlando # 35024 Weil, Matt* # DN17332 Simon, Gelsys # DN24580 Greene, Stephen* NPI: 1457717290 LIC: DN23705 NPI: 1194113373 LIC: DN24580 NPI: 1710250873 LIC: 35024 NPI: 1629154299 LIC: DN17332 # DN24104 Gonzalez Junco, Luis CERTIFICATIONS: # DN21495 # DN18568 Gyles, Richard* Streett, Rosario • Inhalation Sedation NPI: 1447819396 LIC: DN24104 NPI: 1942211180 LIC: DN18568 NPI: 1801230768 LIC: DN21495 # DN22269 Willox, Angela* # DN23700 Gonzalez, Carmen CERTIFICATIONS: # DN24393 Vimo, Belen NPI: 1013120310 LIC: DN22269 NPI: 1285110718 LIC: DN23700 • Pediatric Conscious Sedation NPI: 1144879925 LIC: DN24393 • Inhalation Sedation # DN23529 Gonzalez, Giovanni OSCEOLA COUNTY # DN23764 Wilkins, Lorena • Board Certification NPI: 1417436189 LIC: DN23529 # DN19477 Ojeda Jr., Juan* NPI: 1669950192 LIC: DN23764 DENTIST # DN19802 Hernandez, David NPI: 1861786949 LIC: DN19477 NPI: 1245593896 LIC: DN19802 # FQHC016506 CERTIFICATIONS: # 022972 Osceola Community Centers • Inhalation Sedation # DN19522 Hernandez, Stephanie Dental Excellence Partners @ St. Cloud # DN21821FL Patel, Priya* NPI: 1669751871 LIC: DN19522 LLC 1050 Grape Ave. NPI: 1033573662 LIC: DN21821FL # DN23644 Martinez Morales, 1507 N. John Young Parkway Saint Cloud, FL 34769 Lesner # DN23280 Polanco, Alejandra* Kissimmee, FL 34741 (407) 943-8600 NPI: 1619453743 LIC: DN23644 NPI: 1487181541 LIC: DN23280 (407) 606-8012 Special Needs: Yes CERTIFICATIONS: Special Needs: Yes # DN25261FL Montero, Yenisey English, Spanish English, Spanish • Inhalation Sedation NPI: 1740786599 LIC: DN25261FL # DN16236 Calcagno, Manuel M-T 8am - 5pm # DN23997FL Purcell, Kaitlyn* # DN22889 Mostatabzadeh, Amir NPI: 1194866616 LIC: DN16236 NPI: 1639368145 LIC: DN23997FL # DN14815 Alcequiez, Zeneyda NPI: 1457883019 LIC: DN22889 # DN22843 Canales Carmona, NPI: 1124241989 LIC: DN14815 # DN18959 Robison, Tamara* # DN23899 Moya, Yudit Ashley # DN23321 Aleman, Jose NPI: 1699703355 LIC: DN18959 NPI: 1144793233 LIC: DN23899 General Dentist servicing as: CERTIFICATIONS: NPI: 1770061020 LIC: DN23321 # DN24672 Pilarte, Graciela NPI: 1871018770 LIC: DN22843 • Pediatric Conscious Sedation # DN21645 Baez Henry, # DN15786 Ferro, David • Inhalation Sedation NPI: 1548691017 LIC: DN24672 Carlianette General Dentist servicing as: • Board Certification # DN22255 Rajschmir, Silvina NPI: 1235594961 LIC: DN21645 Pediatric Dentistry # DN20019 Tabares, Yadnay* General Dentist servicing as: NPI: 1063451326 LIC: DN15786 General Dentist servicing as: # DN15630 Cano, Lourdes Pediatric Dentistry Endodontics NPI: 1093867947 LIC: DN15630 NPI: 1679977896 LIC: DN22255 # DN14586 Henninger, Rosalba

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 67 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

General Dentist servicing as: English, Spanish # DN14586 Henninger, Rosalba NPI: 1275527137 LIC: DN23806 Pediatric Dentistry M-T 8am - 5pm General Dentist servicing as: PALM BEACH COUNTY NPI: 1598842668 LIC: DN14586 Th-F 8am - 5pm Pediatric Dentistry # DN20490 Powell, Makom # DN16236 Calcagno, Manuel* NPI: 1598842668 LIC: DN14586 DENTIST General Dentist servicing as: NPI: 1194866616 LIC: DN16236 # DN20490 Powell, Makom Pediatric Dentistry # DN22843 Canales Carmona, General Dentist servicing as: # 016765 NPI: 1154745552 LIC: DN20490 Ashley* Pediatric Dentistry Bella Sonrisa Dental General Dentist servicing as: NPI: 1154745552 LIC: DN20490 # FQHC016507 3729 Lake Worth Rd NPI: 1871018770 LIC: DN22843 Osceola Community Health # 015403 Palm Springs, FL 33461 Centers @ Intercession City # DN15786 Ferro, David* Yes! Dental Associates of (561) 201-8078 Special Needs: Yes 1703 Business Center Lane General Dentist servicing as: Florida Kissimmee, FL 34758 Pediatric Dentistry English, Spanish 701 E. Oak Street Ste B NPI: 1063451326 LIC: DN15786 M-T 10am - 5pm (407) 943-8600 Kissimmee, FL 34744 Special Needs: Yes # DN14586 Henninger, Rosalba* (407) 847-8000 # DN20246 Lago-Sanchez, Idelbis English, Spanish General Dentist servicing as: Special Needs: Yes NPI: 1003248824 LIC: DN20246 M-T 8am - 5pm Pediatric Dentistry English, Spanish # DN16236 Calcagno, Manuel NPI: 1598842668 LIC: DN14586 M-T 9am - 5pm # 022294 NPI: 1194866616 LIC: DN16236 # DN20490 Powell, Makom* W-Th 9am - 4pm Boynton Beach Mall Dental PA # DN22843 Canales Carmona, General Dentist servicing as: # DN16372 Katsur, Justin 801 N. Congress Ave, Ste 185D Ashley Pediatric Dentistry General Dentist servicing as: Boynton Beach, FL 33426 General Dentist servicing as: NPI: 1154745552 LIC: DN20490 Endodontics NPI: 1275592040 LIC: DN16372 (561) 369-7199 NPI: 1871018770 LIC: DN22843 # FQHC016508 Special Needs: Yes CERTIFICATIONS: # DN15786 Ferro, David Osceola Community Health • Inhalation Sedation English, Russian, Spanish General Dentist servicing as: Centers @Poinciana M 10am - 9pm, T 10am - 6pm Pediatric Dentistry ORAL SURGEON 109 N. Doverplum Ave. W-F 10am - 6pm NPI: 1063451326 LIC: DN15786 Kissimmee, FL 34758 # DN25272 Alameri, Mustafa # 011436 # DN14586 Henninger, Rosalba (407) 943-8600 NPI: 1912516626 LIC: DN25272 General Dentist servicing as: Special Needs: Yes Kissimmee Oral Surgery # DN17123 Bravo, Raquel Pediatric Dentistry English, Spanish 3172 Bill Beck Blvd NPI: 1538312525 LIC: DN17123 NPI: 1598842668 LIC: DN14586 M-T 8am - 5pm Kissimmee, FL 34744 # DN17467 Carbot, Mario # DN20490 Powell, Makom W-F 8am - 5pm www.kissimmeeoralsurgery.com General Dentist servicing as: # DN16236 Calcagno, Manuel (407) 483-4939 NPI: 1205051588 LIC: DN17467 Special Needs: Yes Pediatric Dentistry NPI: 1194866616 LIC: DN16236 # DN24313FL Evans, Mana NPI: 1154745552 LIC: DN20490 English, Spanish # DN22843 Canales Carmona, NPI: 1750818712 LIC: DN24313FL M-T 8am - 4pm Ashley # DN24375FL Gaton Molina, Sarah # FQHC016505 W-Th 8am - 4pm General Dentist servicing as: NPI: 1538713979 LIC: DN24375FL Osceola Community Health # DN17160 Ason, Raphael NPI: 1871018770 LIC: DN22843 # DN17335FL Guilarte, Rhona Centers @ Kissimmee NPI: 1659555001 LIC: DN17160 # DN15786 Ferro, David 1875 Fortune Rd. CERTIFICATIONS: NPI: 1619956323 LIC: DN17335FL Kissimmee, FL 34744 General Dentist servicing as: • General Anesthesia # DN22197 Khatib, Adel (407) 943-8600 Pediatric Dentistry # DN23806 Long, Larry Special Needs: Yes NPI: 1063451326 LIC: DN15786

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 68 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

General Dentist servicing as: # DN19634 Cucuras, John* # DN15769 Alonso, Zenaida* Endodontics # FQHC016394 NPI: 1891876322 LIC: DN19634 NPI: 1275586836 LIC: DN15769 NPI: 1235582503 LIC: DN22197 CL Brumback Primary Care # DN17819 Momin, Aysha* # DN20993 Alwehaib, Arwa* # DN16377 Krasnov, Rostislav Clinics NPI: 1649319690 LIC: DN17819 NPI: 1922498070 LIC: DN20993 NPI: 1942267935 LIC: DN16377 1250 Southwinds Dr # DN22922 Oliveira, Paulo* Lantana, FL 33462 # DN19227 Bentsi-Enchill, Flora* # DN20101 Licina, Zeljka NPI: 1285157826 LIC: DN22922 (561) 642-1000 NPI: 1669778353 LIC: DN19227 NPI: 1013263292 LIC: DN20101 Special Needs: Yes # DN8969 Rotella, Robert* # DN19634 Cucuras, John* # DN24055 Lodhi, Hafsa Creoles and Pidgins NPI: 1447320544 LIC: DN8969 NPI: 1891876322 LIC: DN19634 NPI: 1588023584 LIC: DN24055 English-based(other), English, # DN17452 Seminario, Ada* Spanish # DN17819 Momin, Aysha* # DN23728 Lopez, Elssy M-T 8am - 5pm NPI: 1104921592 LIC: DN17452 NPI: 1649319690 LIC: DN17819 NPI: 1215439757 LIC: DN23728 W-F 8am - 5pm # DN22922 Oliveira, Paulo* # DN19470 Maniglia, Marielba # FQHC016393 # DN15769 Alonso, Zenaida* NPI: 1285157826 LIC: DN22922 NPI: 1063793644 LIC: DN19470 CL Brumback Primary Care NPI: 1275586836 LIC: DN15769 # DN8969 Rotella, Robert* # 24529 Moini, Marshall Clinics # DN20993 Alwehaib, Arwa* 1150 45Th St NPI: 1447320544 LIC: DN8969 NPI: 1437700937 LIC: 24529 NPI: 1922498070 LIC: DN20993 West Palm Beach, FL 33407 # DN17452 Seminario, Ada* # DN23652 Ospina, Luz # DN19227 Bentsi-Enchill, Flora* (561) 642-1000 NPI: 1104921592 LIC: DN17452 General Dentist servicing as: Special Needs: Yes NPI: 1669778353 LIC: DN19227 Oral Surgery English, Spanish, Creoles and # DN19634 Cucuras, John* # 006577 NPI: 1881181501 LIC: DN23652 Pidgins French-based(other) NPI: 1891876322 LIC: DN19634 Cross County Dental # DN13621 Tiwary, Alka M-T 8am - 5pm # DN17819 Momin, Aysha* 4288 Okeechobee Blvd NPI: 1154511681 LIC: DN13621 W-F 8am - 5pm West Palm Beach, FL 33409 NPI: 1649319690 LIC: DN17819 # DN24155 Trivedi, Sujay # DN15769 Alonso, Zenaida* (561) 683-6247 # DN22922 Oliveira, Paulo* NPI: 1356909352 LIC: DN24155 NPI: 1275586836 LIC: DN15769 Special Needs: Yes NPI: 1285157826 LIC: DN22922 # DN20993 Alwehaib, Arwa* Russian, Spanish # FQHC016392 NPI: 1922498070 LIC: DN20993 # DN8969 Rotella, Robert* M-T 10am - 6pm CL Brumback Primary Care NPI: 1447320544 LIC: DN8969 Th-F 10am - 6pm # DN19227 Bentsi-Enchill, Flora* Clinics # DN25272 Alameri, Mustafa NPI: 1669778353 LIC: DN19227 # DN17452 Seminario, Ada* 39200 Hooker Highway, Ste 101 NPI: 1104921592 LIC: DN17452 NPI: 1912516626 LIC: DN25272 Belle Glade, FL 33430 # DN19634 Cucuras, John* # DN22246 Antezana, Mauricio (561) 642-1000 NPI: 1891876322 LIC: DN19634 # FQHC016395 General Dentist servicing as: Special Needs: Yes # DN17819 Momin, Aysha* CL Brumback Primary Care Pediatric Dentistry English, Spanish NPI: 1649319690 LIC: DN17819 Clinics NPI: 1063876399 LIC: DN22246 M-T 8am - 5pm 225 S. Congress Ave W-F 8am - 5pm # DN22922 Oliveira, Paulo* # DN21079 Arnedo, Johanna Delray Beach, FL 33445 NPI: 1285157826 LIC: DN22922 General Dentist servicing as: # DN15769 Alonso, Zenaida* hcdpbc.org Pediatric Dentistry NPI: 1275586836 LIC: DN15769 # DN8969 Rotella, Robert* (531) 585-5989 NPI: 1104213909 LIC: DN21079 NPI: 1447320544 LIC: DN8969 # DN20993 Alwehaib, Arwa* Special Needs: Yes CERTIFICATIONS: NPI: 1922498070 LIC: DN20993 # DN17452 Seminario, Ada* English, Farsi, Creoles and Pidgins • Inhalation Sedation (other), Spanish NPI: 1104921592 LIC: DN17452 # DN17412 Atkinson, William # DN19227 Bentsi-Enchill, Flora* M-T 8am - 5pm NPI: 1669778353 LIC: DN19227 W-F 8am - 5pm

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 69 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

General Dentist servicing as: NPI: 1437700937 LIC: 24529 NPI: 1093867947 LIC: DN15630 DOH - Palm Beach Cty Hlth Pediatric Dentistry # DN23402 Montenegro, Christian # DN21572 Carballo, Mauro Dept- REFERRAL BASED NPI: 1942360862 LIC: DN17412 NPI: 1144714445 LIC: DN23402 NPI: 1508200635 LIC: DN21572 LOCATION ONLY CERTIFICATIONS: 851 Ave P • Inhalation Sedation # DN23652 Ospina, Luz # DN23695 Cruz, Yanet Riviera Beach, FL 33404 General Dentist servicing as: NPI: 1508225376 LIC: DN23695 # DN17123 Bravo, Raquel (561) 803-7352 Oral Surgery NPI: 1538312525 LIC: DN17123 # DN23705 Diaz Valle, Orlando Special Needs: No NPI: 1881181501 LIC: DN23652 # DN21812 Cabrera, Rene NPI: 1457717290 LIC: DN23705 English, Spanish, Creoles and # DN23021 Riboul, Sandrine Pidgins French-based(other) General Dentist servicing as: # DN23700 Gonzalez, Carmen Pediatric Dentistry NPI: 1609227057 LIC: DN23021 M-T 8am - 5pm NPI: 1285110718 LIC: DN23700 NPI: 1518313675 LIC: DN21812 CERTIFICATIONS: W-F 8am - 5pm # DN23529 Gonzalez, Giovanni • Inhalation Sedation # DN11165 Staten, William* # DN7894 Cullen, William # DN23007 Rivera, Lina NPI: 1417436189 LIC: DN23529 General Dentist servicing as: NPI: 1114029170 LIC: DN11165 NPI: 1760908743 LIC: DN23007 # DN19802 Hernandez, David Pediatric Dentistry # DN8637 Woersching, Douglas* NPI: 1245593896 LIC: DN19802 NPI: 1013110535 LIC: DN7894 # DN20475 Santiago, Germaine NPI: 1598871758 LIC: DN8637 CERTIFICATIONS: NPI: 1922341460 LIC: DN20475 # DN19522 Hernandez, Stephanie • Inhalation Sedation # 013217 # DN23257 Shippee, Rebecca NPI: 1669751871 LIC: DN19522 # DN24313FL Evans, Mana Dr. Michael D. Quasha NPI: 1841778164 LIC: DN23257 # DN23644 Martinez Morales, NPI: 1750818712 LIC: DN24313FL 4520 Donald Ross Road, Ste 105 # DN18770 Trujillo, Madelene Lesner # DN20710 Gonzalez, Kely Palm Beach Gardens, FL 33418 NPI: 1881835767 LIC: DN18770 NPI: 1619453743 LIC: DN23644 NPI: 1952717027 LIC: DN20710 (561) 799-5558 # DN24672 Pilarte, Graciela # DN21066 Uzunova-Dimova, Special Needs: # DN17335FL Guilarte, Rhona Kalina NPI: 1548691017 LIC: DN24672 English, Arabic, French, Spanish NPI: 1619956323 LIC: DN17335FL General Dentist servicing as: # DN22255 Rajschmir, Silvina M-T 9:30 am - 4:30 pm # DN23847 Khan, Adiba Pediatric Dentistry General Dentist servicing as: W-F 9:30 am - 4:30 pm NPI: 1245540947 LIC: DN21066 NPI: 1649638172 LIC: DN23847 Pediatric Dentistry # DN16005 Quasha, Michael NPI: 1679977896 LIC: DN22255 # DN22197 Khatib, Adel # EV1135105 NPI: 1972674448 LIC: DN16005 # DN22999 Reyes, Christina General Dentist servicing as: Dental Excellence Partners Endodontics NPI: 1679931000 LIC: DN22999 # EV541904 11700 Okeechobee Blvd NPI: 1235582503 LIC: DN22197 Elite Dental Of Jupiter West Palm Beach, FL 33411 # DN24107 Serhan Lopez, Nayef # DN16377 Krasnov, Rostislav 1025 Military Trl Ste 210 (561) 708-6068 NPI: 1184282550 LIC: DN24107 NPI: 1942267935 LIC: DN16377 Jupiter, FL 33458 Special Needs: Yes # DN17332 Simon, Gelsys (561) 295-1566 # DN24131 Krupnov, Vera English, Spanish NPI: 1629154299 LIC: DN17332 Special Needs: Yes NPI: 1386202984 LIC: DN24131 M-T 8am - 5pm # DN21495 Streett, Rosario English, Russian, Spanish W-F 8am - 5pm # DN20101 Licina, Zeljka NPI: 1801230768 LIC: DN21495 M-T 9am - 5pm # DN23321 Aleman, Jose NPI: 1013263292 LIC: DN20101 W-F 9am - 5pm # DN24393 Vimo, Belen NPI: 1770061020 LIC: DN23321 # DN24055 Lodhi, Hafsa NPI: 1144879925 LIC: DN24393 # DN25165FL Alrubaye, Hiba # DN21645 Baez Henry, NPI: 1588023584 LIC: DN24055 NPI: 1477059129 LIC: DN25165FL Carlianette # DN23764 Wilkins, Lorena # DN19470 Maniglia, Marielba # DN10457FL Broggi, Edward NPI: 1235594961 LIC: DN21645 NPI: 1669950192 LIC: DN23764 NPI: 1063793644 LIC: DN19470 NPI: 1215955190 LIC: DN10457FL # DN15630 Cano, Lourdes # CHC015386 # 24529 Moini, Marshall # DN25050 Gross, Steven

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 70 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1063029122 LIC: DN25050 Boynton Beach, FL 33435 # FQHC014906 # 021850 # DN23454FL Nguyen, Michelle www Foundcare, Inc. (561) 810-8790 Nona Diamond Dental LLC General Dentist servicing as: Endodontics 2330 S. Congress Ave Special Needs: Yes 1696 S. Military Trail # B NPI: 1033603733 LIC: DN23454FL West Palm Beach, FL 33406 English, Spanish West Palm Beach, FL 33415 CERTIFICATIONS: (561) 432-5849 M-T 8am - 5pm nonadiamonddental.com • Inhalation Sedation Special Needs: Yes W-Th 8am - 5pm (561) 791-6494 Special Needs: Yes # DN24429FL Shahriari, English, Arabic, Creoles and # DN12125 Berry, Wayne Pidgins French-based(other), Varahram General Dentist servicing as: English, Spanish, Portuguese French, Spanish General Dentist servicing as: Pediatric Dentistry M-T 8am - 5pm M-T 8am - 4pm Endodontics NPI: 1053324376 LIC: DN12125 W-Th 8am - 5pm W-F 8am - 4pm NPI: 1952954778 LIC: DN24429FL # DN24596FL Diaz, Gloria # DN20957 Correa, Ali # DN23592 Lacroze, Dorotie # DN16481 Zadov, Marianna NPI: 1427149459 LIC: DN24596FL NPI: 1972815835 LIC: DN20957 NPI: 1104329978 LIC: DN23592 NPI: 1104903301 LIC: DN16481 # DN20219 Elkind, Jaime # DN12194 Rampertaap, # 021802 CERTIFICATIONS: NPI: 1437567146 LIC: DN20219 • Inhalation Sedation Maheswar Pediatric & General NPI: 1235290602 LIC: DN12194 # DN18189 Rizzardi, Suzanne Dentistry of Palm Beach # 006676 NPI: 1861666232 LIC: DN18189 1620 S. Congress Ave, Ste 102 Florida Dental & Denture # FQHC014974 Palm Springs, FL 33461 Center Genesis Community Health # 020193 (561) 508-5930 1901 S. Federal Hwy Inc Heavenly Smiles Special Needs: Yes Boynton Beach, FL 33435 181 Crawford Blvd 135 South Us Highway 27 English, Spanish (561) 738-5974 Boca Raton, FL 33432 South Bay, FL 33493 M-T 9am - 5pm Special Needs: Yes www.gencomhealth.org (561) 996-0033 W-F 9am - 5pm English, Spanish (561) 235-5477 Special Needs: Yes # DN23641 Moynelo, Camilo* M-T 9am - 5pm Special Needs: Yes English, Spanish, Creoles and NPI: 1376039115 LIC: DN23641 W-F 9am - 5pm English, Spanish, Creoles and Pidgins English-based(other) M-T 8:30 am - 4:30 pm # DN13168 Semeah, Yves Pidgins (other) # 007645 M-T 8:30 am - 5pm NPI: 1326152463 LIC: DN13168 # DN21975 Baldwin, Anthony Polo Dental W-F 8:30 am - 5pm NPI: 1073066551 LIC: DN21975 1905 Clint Moore Rd, Ste 200 # DN12125 Berry, Wayne # 006678 Boca Raton, FL 33496 # 019498 Florida Dental & Denture General Dentist servicing as: (561) 241-7656 Pediatric Dentistry Center III Lidia Suarez DDS Inc Special Needs: Yes NPI: 1053324376 LIC: DN12125 2945 N. Australian Ave 1800 Forest Hill Blvd Ste A 3/4 English, Russian, Creoles and West Palm Beach, FL 33407 # DN20219 Elkind, Jaime West Palm Beach, FL 33406 Pidgins French-based(other), (561) 844-0033 NPI: 1437567146 LIC: DN20219 www.suarezlidiadds.com Spanish Special Needs: No (561) 249-6114 M-T 9am - 5pm # DN18189 Rizzardi, Suzanne Spanish, English Special Needs: Yes W-F 9am - 5pm NPI: 1861666232 LIC: DN18189 M-T 9am - 5pm English, Spanish # DN25165FL Alrubaye, Hiba # DN8737 Newman, Donald # FQHC017622 M-T 9am - 5pm NPI: 1477059129 LIC: DN25165FL W-F 9am - 5pm NPI: 1356476857 LIC: DN8737 Genesis Community Health, # DN20845 Bradley, Alijah # DN20107 Suarez Tabares, Lidia # DN13168 Semeah, Yves Inc. NPI: 1003224148 LIC: DN20845 NPI: 1780976795 LIC: DN20107 NPI: 1326152463 LIC: DN13168 2623 S. Seacrest Blvd Ste 112

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 71 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN10457FL Broggi, Edward English, Spanish General Dentist servicing as: # DN14857 Gonzalez-Fujara, NPI: 1215955190 LIC: DN10457FL M-T 8:30 am - 5am Endodontics Maria W-Th 8:30 am - 6:30 am NPI: 1023280807 LIC: DN13556 NPI: 1922133099 LIC: DN14857 # DN25050 Gross, Steven # DN21250FL Prado, Pablo # DN24429FL Shahriari, NPI: 1063029122 LIC: DN25050 ENDODONTICS NPI: 1104207703 LIC: DN21250FL Varahram # DN23454FL Nguyen, Michelle General Dentist servicing as: General Dentist servicing as: # 010039 Endodontics # 022294 Endodontics Quantum Dental NPI: 1952954778 LIC: DN24429FL Boynton Beach Mall Dental NPI: 1033603733 LIC: DN23454FL 1034 Gateway Blvd, Ste 101 # DN16481 Zadov, Marianna PA CERTIFICATIONS: NPI 1104903301 LIC: DN16481 801 N. Congress Ave, Ste 185D • Inhalation Sedation Boynton Beach, FL 33426 : Boynton Beach, FL 33426 (561) 249-2585 CERTIFICATIONS: # DN13556 Schreiber, Page Special Needs: Yes • Inhalation Sedation (561) 369-7199 General Dentist servicing as: Special Needs: Yes English, Spanish Endodontics # 009637 English, Russian, Spanish M-T 9am - 5pm NPI: 1023280807 LIC: DN13556 Sage Dental of Belle Glade, M 10am - 9pm, T 10am - 6pm # DN17323 Deyab, Tim # DN24429FL Shahriari, P.A. W-F 10am - 6pm NPI: 1124119474 LIC: DN17323 Varahram 427 Se 2Nd St # DN13421 Gittess, Robert General Dentist servicing as: Belle Glade, FL 33430 # 016245 NPI: 1922137058 LIC: DN13421 Endodontics (561) 996-6006 Royal Dental NPI: 1952954778 LIC: DN24429FL Special Needs: Yes # 006577 1301 N. Congress, Ste 110 # DN16481 Zadov, Marianna English, Spanish, Creoles and Cross County Dental Boynton Beach, FL 33426 Pidgins English-based(other) NPI: 1104903301 LIC: DN16481 4288 Okeechobee Blvd (561) 292-0155 M-T 8am - 5pm CERTIFICATIONS: West Palm Beach, FL 33409 Special Needs: Yes W-F 8am - 5pm • Inhalation Sedation (561) 683-6247 English, Russian, Spanish # DN19079 Fernandez-Martinez, Special Needs: Yes # 008259 M-T 9am - 5pm Mariangel* Russian, Spanish Premiere Dental Care, PL W-F 9am - 5pm NPI: 1376857441 LIC: DN19079 M-T 10am - 6pm # DN25165FL Alrubaye, Hiba 600 S Dixie Hwy, Ste 105 # DN17837 Snider-Gomez, Erica* Th-F 10am - 6pm West Palm Beach, FL 33401 NPI: 1477059129 LIC: DN25165FL NPI: 1073702767 LIC: DN17837 # DN13421 Gittess, Robert (561) 820-8898 # DN10457FL Broggi, Edward NPI: 1922137058 LIC: DN13421 Special Needs: Yes # DN14972 Stein, Ilya* NPI: 1215955190 LIC: DN10457FL NPI: 1235260407 LIC: DN14972 English, Chinese Mandarin, ORAL SURGEON Russian, Spanish # DN25050 Gross, Steven M 9am - 5pm, T 9am - 7pm NPI: 1063029122 LIC: DN25050 # 015450 # 020366 Th-F 9am - 6pm # DN25513FL Koval, Svitlana Sky Dental Florida Dental For Oral # DN12723 Hui, Tin NPI: 1740888486 LIC: DN25513FL 625 Se 2Nd Ave, Ste D Surgery & Dental Implants NPI: 1952408619 LIC: DN12723 Boynton Beach, FL 33435 # DN23454FL Nguyen, Michelle 4953 Lechalet Blvd, Ste 1 myskydentist.com General Dentist servicing as: Boynton Beach, FL 33436 # EV1079990 (561) 739-3222 Endodontics (954) 838-0621 Prestige Dental Care Special Needs: No NPI: 1033603733 LIC: DN23454FL Special Needs: Yes English, Spanish 6169 S Jog Rd Ste B2 CERTIFICATIONS: English, Spanish, Creoles and M-T 9am - 5pm Lake Worth, FL 33467 • Inhalation Sedation Pidgins (other), French W-Th 9am - 5pm (561) 965-3933 # DN13556 Schreiber, Page M-T 9am - 5pm Special Needs: Yes

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 72 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

W-F 9am - 5pm CL Brumback Primary Care CL Brumback Primary Care CERTIFICATIONS: • Inhalation Sedation # DN16448 Smith, Damone Clinics Clinics # DN11699 NPI: 1780718411 LIC: DN16448 39200 Hooker Highway, Ste 101 225 S. Congress Ave Simon, David CERTIFICATIONS: Belle Glade, FL 33430 Delray Beach, FL 33445 NPI: 1508303587 LIC: DN11699 • Pediatric Conscious Sedation (561) 642-1000 hcdpbc.org CERTIFICATIONS: • Oral / Enteral Sedation Special Needs: Yes (531) 585-5989 • Oral / Enteral Sedation • Intravenous Sedation English, Spanish Special Needs: Yes # 016245 • Inhalation Sedation M-T 8am - 5pm English, Farsi, Creoles and Pidgins • General Anesthesia W-F 8am - 5pm (other), Spanish Royal Dental • Conscious Sedation M-T 8am - 5pm # DN19391 Zangeneh, Yasmine* 1301 N. Congress, Ste 110 ORTHODONTIST W-F 8am - 5pm Boynton Beach, FL 33426 NPI: 1841586567 LIC: DN19391 # DN19391 Zangeneh, Yasmine* (561) 292-0155 # 022294 # FQHC016393 NPI: 1841586567 LIC: DN19391 Special Needs: Yes Boynton Beach Mall Dental CL Brumback Primary Care English, Russian, Spanish PERIODONTICS M-T 9am - 5pm PA Clinics W-F 9am - 5pm 801 N. Congress Ave, Ste 185D 1150 45Th St # 006577 Boynton Beach, FL 33426 West Palm Beach, FL 33407 # DN23115 Mendoza, Juan (561) 369-7199 (561) 642-1000 Cross County Dental NPI: 1821326430 LIC: DN23115 Special Needs: Yes Special Needs: Yes 4288 Okeechobee Blvd CERTIFICATIONS: English, Russian, Spanish English, Spanish, Creoles and West Palm Beach, FL 33409 • Inhalation Sedation M 10am - 9pm, T 10am - 6pm Pidgins French-based(other) (561) 683-6247 # DN11699 Simon, David W-F 10am - 6pm M-T 8am - 5pm Special Needs: Yes NPI: 1508303587 LIC: DN11699 W-F 8am - 5pm # DN13474 Gittess, Laurie Russian, Spanish CERTIFICATIONS: NPI: 1346321031 LIC: DN13474 # DN19391 Zangeneh, Yasmine* M-T 10am - 6pm • Oral / Enteral Sedation NPI: 1841586567 LIC: DN19391 Th-F 10am - 6pm PASCO COUNTY # 007645 # DN13591 Nielsen, Pamela # FQHC016394 Polo Dental NPI: 1124118245 LIC: DN13591 DENTIST CL Brumback Primary Care 1905 Clint Moore Rd, Ste 200 # DN23099 Rodriguez, Iveliss Boca Raton, FL 33496 Clinics NPI: 1962971200 LIC: DN23099 # FQHC011082 1250 Southwinds Dr (561) 241-7656 Premier Community Special Needs: Yes Lantana, FL 33462 # 007645 HealthCare Group, Inc. English, Russian, Creoles and (561) 642-1000 Polo Dental 37944 Pasco Ave Pidgins French-based(other), Special Needs: Yes Dade City, FL 33525 Spanish Creoles and Pidgins 1905 Clint Moore Rd, Ste 200 PREMIERHC.ORG M-T 9am - 5pm English-based(other), English, Boca Raton, FL 33496 (352) 518-2000 W-F 9am - 5pm Spanish (561) 241-7656 M-T 8am - 5pm Special Needs: Yes Special Needs: Yes # DN19915 Naghavi, Nona W-F 8am - 5pm English, Russian, Creoles and English, Spanish NPI: 1649318262 LIC: DN19915 Pidgins French-based(other), M 7am - 7pm, T 7am - 4pm # DN19391 Zangeneh, Yasmine* Spanish W-F 7am - 4pm PEDIATRIC DENTISTRY NPI: 1841586567 LIC: DN19391 M-T 9am - 5pm # DN24159 Au, Anna W-F 9am - 5pm # FQHC016392 # FQHC016395 NPI: 1174182463 LIC: DN24159 # DN23115 Mendoza, Juan # DN11556 Baker, Wayne NPI: 1821326430 LIC: DN23115

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 73 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1699833947 LIC: DN11556 W-F 7am - 4pm Community Health Centers ORAL SURGEON # DN14806 Barinas-Duval, # DN13891 Peralta, Jose of Pinellas Inc. Froilan NPI: 1962462036 LIC: DN13891 4950 34Th St N # 012639 General Dentist servicing as: Saint Petersburg, FL 33714 Pediatric Dentistry # FQHC697934 Tampa Bay Institute of Oral (727) 824-8181 NPI: 1699748442 LIC: DN14806 Premier Community Surgery & Dental Implants Special Needs: Yes 19445 Shumard Oak Dr Ste 101 CERTIFICATIONS: HealthCare Group, Inc. English Land O Lakes, FL 34638 • Inhalation Sedation 37615 Martin Luther King Blvd M-T 7am - 4pm https://tampabayos.com # DN23246 Boodhoo, Amanda Dade City, FL 33523 W-F 7am - 4pm (813) 909-2354 General Dentist servicing as: (352) 518-2000 # DN24492 Colvin, Joshua Special Needs: Yes Pediatric Dentistry Special Needs: Yes NPI: 1447806484 LIC: DN24492 English, Spanish NPI: 1639531460 LIC: DN23246 English, Spanish M-T 8am - 4:30 pm # DN19885 Dougherty, Erin # HAD27 Genho, Beth M 7am - 7pm, T 7am - 4pm W-F 8am - 4:30 pm NPI: 1043565807 LIC: DN19885 W-F 7am - 4pm NPI: 1942491154 LIC: HAD27 # DN18163FL Aves, Renato # DN22252 Elan, Subanitha # DN23246 Boodhoo, Amanda # HAD33 Modaff, Michelle General Dentist servicing as: NPI: 1336322650 LIC: DN18163FL NPI: 1255876017 LIC: DN22252 NPI: 1497768295 LIC: HAD33 Pediatric Dentistry CERTIFICATIONS: # DN25385 Hicks, Michael # DN19998 Nazco-Batista, Maria • Inhalation Sedation NPI: 1639531460 LIC: DN23246 NPI: 1407347107 LIC: DN25385 General Dentist servicing as: • General Anesthesia # HAD27 Genho, Beth # DN23673 Pediatric Dentistry # DN19301 Caribas-Mendible, Migliaccio, Carla NPI: 1942491154 LIC: HAD27 NPI: 1093050676 LIC: DN19998 Alejandro NPI: 1700347671 LIC: DN23673 CERTIFICATIONS: NPI: 1013204122 LIC: DN19301 # FQHC697936 # DN25357 Santos, Leidy • Inhalation Sedation CERTIFICATIONS: General Dentist servicing as: Premier Community # DN20707 Painter, Lisa • Inhalation Sedation Endodontics HealthCare Group, Inc. • General Anesthesia NPI: 1083031926 LIC: DN20707 NPI: 1376155937 LIC: DN25357 10841 Little Rd # DN23977 Elmohd, Tarik # DN13891 Peralta, Jose New Port Richey, FL 34654 # DN21962 Trenkova, Violeta NPI: 1538556329 LIC: DN23977 NPI: 1962462036 LIC: DN13891 www.premierhc.org NPI: 1841641792 LIC: DN21962 (352) 518-2000 # DN22607 Rotaru, Ion PINELLAS COUNTY Special Needs: Yes # FQHC011250 General Dentist servicing as: Community Health Centers Pediatric Dentistry English, Spanish DENTIST of Pinellas, Inc NPI: 1558899658 LIC: DN22607 M 7am - 7pm, T 7am - 4pm W-F 7am - 4pm # 011420 1344 22Nd Street S # DN19476 Thomas, Kelly St Petersburg, FL 33712 # DN23246 Boodhoo, Amanda A-1 Dental NPI: 1821374828 LIC: DN19476 (727) 824-8181 General Dentist servicing as: 29605 Us 19 North, Ste 350 Special Needs: Yes # FQHC1141174 Pediatric Dentistry Clearwater, FL 33761 English, Spanish NPI: 1639531460 LIC: DN23246 (727) 786-6649 Premier Community M-T 7am - 6pm # HAD27 Genho, Beth Special Needs: No HealthCare Group, Inc. W-Th 7am - 6pm English, Gujarati, Hindi 6906 Madison St NPI: 1942491154 LIC: HAD27 # DN21300 Alonso, Anamevys New Port Richey, FL 34652 M 9am - 5pm, T 10am - 6pm # DN20707 Painter, Lisa General Dentist servicing as: (352) 518-2000 # DN11504 Patel, Guarangi NPI: 1083031926 LIC: DN20707 Pediatric Dentistry Special Needs: Yes NPI: 1326123993 LIC: DN11504 # DN13891 Peralta, Jose NPI: 1669868147 LIC: DN21300 English, Spanish # DN22253 Carter, Jade M 7am - 7pm, T 7am - 4pm NPI: 1962462036 LIC: DN13891 # FQHC930751

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 74 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1487968467 LIC: DN22253 # DN24492 Colvin, Joshua # DN23673 Migliaccio, Carla NPI: 1235582503 LIC: DN22197

# DN24492 Colvin, Joshua NPI: 1447806484 LIC: DN24492 NPI: 1700347671 LIC: DN23673 # DN16377 Krasnov, Rostislav NPI: 1447806484 LIC: DN24492 # DN19885 Dougherty, Erin # DN25357 Santos, Leidy NPI: 1942267935 LIC: DN16377

# DN19885 Dougherty, Erin NPI: 1043565807 LIC: DN19885 General Dentist servicing as: # DN24131 Krupnov, Vera Endodontics NPI: 1043565807 LIC: DN19885 # DN22252 Elan, Subanitha NPI: 1386202984 LIC: DN24131 NPI: 1376155937 LIC: DN25357 # DN22252 Elan, Subanitha NPI: 1255876017 LIC: DN22252 # DN20101 Licina, Zeljka # DN21962 Trenkova, Violeta NPI: 1255876017 LIC: DN22252 # DN25385 Hicks, Michael NPI: 1013263292 LIC: DN20101 NPI: 1841641792 LIC: DN21962 # DN25385 Hicks, Michael NPI: 1407347107 LIC: DN25385 # 24529 Moini, Marshall NPI: 1407347107 LIC: DN25385 # DN9873 Lansmann, Richard # FQHC1141123 NPI: 1437700937 LIC: 24529

# DN9873 Lansmann, Richard NPI: 1427355585 LIC: DN9873 Community Health Centers # DN23652 Ospina, Luz NPI: 1427355585 LIC: DN9873 # DN23673 Migliaccio, Carla of Pinellas, Inc. General Dentist servicing as: 14100 58Th St N Oral Surgery # DN23673 Migliaccio, Carla NPI: 1700347671 LIC: DN23673 Clearwater, FL 33760 NPI: 1881181501 LIC: DN23652 # DN25357 NPI: 1700347671 LIC: DN23673 Santos, Leidy (727) 824-8181 # DN13621 Tiwary, Alka # DN25357 Santos, Leidy General Dentist servicing as: Special Needs: Yes Endodontics NPI: 1154511681 LIC: DN13621 General Dentist servicing as: English Endodontics NPI: 1376155937 LIC: DN25357 M-T 7am - 4pm # CHC10109 NPI: 1376155937 LIC: DN25357 # DN24535 Tanner, Jonathan W-F 7am - 4pm DOH - Pinellas County NPI: 1720623606 LIC: DN24535 # DN24535 Tanner, Jonathan # DN19885 Dougherty, Erin Health Department NPI: 1720623606 LIC: DN24535 # DN21962 Trenkova, Violeta NPI: 1043565807 LIC: DN19885 205 Dr. Martin Luther King St # DN21962 Trenkova, Violeta NPI: 1841641792 LIC: DN21962 No. # 022289 Saint Petersburg, FL 33701 NPI: 1841641792 LIC: DN21962 # FQHC931200 Countryside Mall Dental PA (727) 824-6900 # FQHC011251 Community Health Centers 27001 Us Highway 19 N, Ste Special Needs: Yes Community Health Centers of Pinellas, Inc 1031B English, Spanish of Pinellas, Inc 721 E. Lime St. Clearwater, FL 33761 M-T 8am - 5pm (727) 669-1600 W-F 8am - 5pm 702 Jasmine Way Tarpon Springs, FL 34689 Special Needs: Yes Clearwater, FL 33756 (727) 824-8181 # DN12823 Beers, Eda Special Needs: Yes English, Russian, Spanish (727) 824-8181 NPI: 1437118460 LIC: DN12823 English M-T 10am - 9pm Special Needs: Yes CERTIFICATIONS: W-F 10am - 9pm English, Spanish M-T 7am - 4pm • Inhalation Sedation W-F 7am - 4pm S 10am - 9pm, Su 11 am - 6 pm M 7:30 am - 6pm, T 7:30 am - # DN12874 Chekan, Theodore 4:30 pm # DN24492 # DN17123 Bravo, Raquel Colvin, Joshua NPI: 1992750426 LIC: DN12874 W 7:30 am - 4:30 pm, Th 7:30 NPI: 1447806484 LIC: DN24492 NPI: 1538312525 LIC: DN17123 am - 6pm, F 7:30 am - 4:30 pm # DN13061 Engelman, Sharon # DN19885 Dougherty, Erin # DN24313FL Evans, Mana # DN21300 Alonso, Anamevys NPI: 1215996384 LIC: DN13061 NPI: 1043565807 LIC: DN19885 NPI: 1750818712 LIC: DN24313FL General Dentist servicing as: # DN18300 Gatons, Yelena # DN22252 # DN17335FL Guilarte, Rhona Pediatric Dentistry Elan, Subanitha NPI: 1326202474 LIC: DN18300 NPI: 1669868147 LIC: DN21300 NPI: 1255876017 LIC: DN22252 NPI: 1619956323 LIC: DN17335FL # DN12521 Lense, Pedro # DN22253 Carter, Jade # DN25385 # DN22197 Khatib, Adel Hicks, Michael NPI: 1154380913 LIC: DN12521 NPI: 1487968467 LIC: DN22253 NPI: 1407347107 LIC: DN25385 General Dentist servicing as: Endodontics # DN11690 Saraydar, Haychell

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 75 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

NPI: 1750343257 LIC: DN11690 M-T 8am - 5pm # DN18300 Gatons, Yelena W-F 8am - 5pm # 010840 # DN11179 Wong, Elaine NPI: 1326202474 LIC: DN18300 St. Petersburg Dental Clinic NPI: 1295794360 LIC: DN11179 # DN12823 Beers, Eda* # DN11984 Gonzalez, Jose 9200 113Th Street N. NPI: 1437118460 LIC: DN12823 NPI: 1992706691 LIC: DN11984 # CHC10125 CERTIFICATIONS: Seminole, FL 33772 # DN12521 Lense, Pedro DOH - Pinellas County • Inhalation Sedation (727) 394-6064 NPI: 1154380913 LIC: DN12521 Special Needs: Yes Health Department # DN12874 Chekan, Theodore English, Spanish 8751 Ulmerton Rd NPI: 1992750426 LIC: DN12874 # DN11690 Saraydar, Haychell M-T 7:30 am - 4pm Largo, FL 33771 NPI: 1750343257 LIC: DN11690 # DN13061 Engelman, Sharon* W-F 7:30 am - 4pm (727) 824-6900 NPI: 1215996384 LIC: DN13061 # DN11179 Wong, Elaine Special Needs: Yes # DTP400 Gibbs, Micaela NPI: 1295794360 LIC: DN11179 English, Spanish # DN18300 Gatons, Yelena* NPI: 1902862469 LIC: DTP400 NPI: 1326202474 LIC: DN18300 M-T 8am - 5pm # CHC10129 # DN18620 Viera, Gretel W-F 8am - 5pm # DN12521 Lense, Pedro DOH - Pinellas County General Dentist servicing as: # DN12823 Beers, Eda NPI: 1154380913 LIC: DN12521 Health Department Endodontics NPI: 1790915635 LIC: DN18620 NPI: 1437118460 LIC: DN12823 # DN11690 Saraydar, Haychell* 310 N. Myrtle Ave CERTIFICATIONS: Clearwater, FL 33755 NPI: 1750343257 LIC: DN11690 # 011546 • Inhalation Sedation (727) 275-6535 # DN19476 Thomas, Kelly* # DN12874 Chekan, Theodore Special Needs: Yes Tyrone Square Mall Dental NPI: 1821374828 LIC: DN19476 NPI: 1992750426 LIC: DN12874 English, Spanish PA # DN17405 Ward, Tasha* M-T 8am - 5pm 6747 Tyrone Square # DN13061 Engelman, Sharon Saint Petersburg, FL 33710 NPI: 1528087871 LIC: DN17405 W-F 8am - 5pm NPI: 1215996384 LIC: DN13061 (727) 345-6100 # DN11179 Wong, Elaine* # DN12823 Beers, Eda # DN18300 Gatons, Yelena Special Needs: Yes NPI: 1295794360 LIC: DN11179 NPI: 1437118460 LIC: DN12823 NPI: 1326202474 LIC: DN18300 English, Spanish CERTIFICATIONS: M-T 11am - 8pm # DN11984 Gonzalez, Jose # CHC10127 • Inhalation Sedation W-F 11am - 8pm NPI: 1992706691 LIC: DN11984 # DN12874 Chekan, Theodore DOH - Pinellas County S 12pm - 4pm, Su 12 pm - 4 pm NPI: 1992750426 LIC: DN12874 # DN12521 Lense, Pedro Health Department # DN22246 Antezana, Mauricio 6350 76Th Ave North NPI: 1154380913 LIC: DN12521 # DN13061 Engelman, Sharon General Dentist servicing as: Pinellas Park, FL 33781 # DN11690 Saraydar, Haychell NPI: 1215996384 LIC: DN13061 Pediatric Dentistry (727) 547-7780 NPI: 1063876399 LIC: DN22246 NPI: 1750343257 LIC: DN11690 Special Needs: Yes # DN18300 Gatons, Yelena # DN21079 Arnedo, Johanna # DN11179 Wong, Elaine English, Spanish NPI: 1326202474 LIC: DN18300 General Dentist servicing as: NPI: 1295794360 LIC: DN11179 # DN12823 # DN11984 Gonzalez, Jose Beers, Eda Pediatric Dentistry NPI: 1437118460 LIC: DN12823 NPI: 1992706691 LIC: DN11984 # CHC10126 NPI: 1104213909 LIC: DN21079 CERTIFICATIONS: # DN12521 Lense, Pedro CERTIFICATIONS: DOH - Pinellas County • Inhalation Sedation NPI: 1154380913 LIC: DN12521 • Inhalation Sedation Health Department # DN12874 Chekan, Theodore # DN17412 Atkinson, William 12420 130Th Ave North # DN11690 Saraydar, Haychell NPI: 1992750426 LIC: DN12874 General Dentist servicing as: Largo, FL 33774 NPI: 1750343257 LIC: DN11690 # DN13061 Engelman, Sharon Pediatric Dentistry (727) 824-6900 # DN11179 Wong, Elaine NPI: 1942360862 LIC: DN17412 Special Needs: Yes NPI: 1215996384 LIC: DN13061 NPI: 1295794360 LIC: DN11179 CERTIFICATIONS: 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 76 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

• Inhalation Sedation # DN13621 Tiwary, Alka # HAD80 Antony, Archana NPI: 1861940850 LIC: DN22245 # DN17123 Bravo, Raquel NPI: 1154511681 LIC: DN13621 General Dentist servicing as: # DN6990 Seifert, Thomas NPI: 1538312525 LIC: DN17123 Pediatric Dentistry # DN21066 Uzunova-Dimova, General Dentist servicing as: NPI: 1851607766 LIC: HAD80 # DN21812 Cabrera, Rene Kalina Pediatric Dentistry # DN23942 Cameron, Casey NPI: 1255654232 LIC: DN6990 General Dentist servicing as: General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry NPI: 1548758147 LIC: DN23942 # DN15069 Suri, Niki NPI: 1518313675 LIC: DN21812 NPI: 1245540947 LIC: DN21066 # HAD79 Cocchieri, Richard NPI: 1316129182 LIC: DN15069 # DN24313FL Evans, Mana General Dentist servicing as: ORAL SURGEON # CHC7921 NPI: 1750818712 LIC: DN24313FL Pediatric Dentistry NPI: 1578685491 LIC: HAD79 Central Florida Health Care # DN20710 Gonzalez, Kely # EV824913 # HAD92 Coello, Marla 305 W. Central Ave NPI: 1952717027 LIC: DN20710 Tampa Bay Maxillofacial NPI: 1891833620 LIC: HAD92 Lake Wales, FL 33853 # DN17335FL Guilarte, Rhona Surgery (863) 855-9718 # DN12668 Congote, Luis NPI: 1619956323 LIC: DN17335FL 2140 16Th St N Special Needs: Yes St Petersburg, FL 33704 General Dentist servicing as: # DN23847 Khan, Adiba Spanish, English Pediatric Dentistry www.perioralsurgery.com M-T 7:30 am - 5pm NPI: 1649638172 LIC: DN23847 NPI: 1679774426 LIC: DN12668 (727) 894-1442 W-F 7:30 am - 5pm # DN22197 Khatib, Adel Special Needs: No # DN13255 Cooper, Angela # DN22773 Aiyede, Onize General Dentist servicing as: English General Dentist servicing as: General Dentist servicing as: Endodontics M-T 8am - 5pm Pediatric Dentistry Pediatric Dentistry NPI: 1235582503 LIC: DN22197 W-Th 8am - 5pm NPI: 1912994914 LIC: DN13255 NPI: 1306295712 LIC: DN22773 # DN24131 Krupnov, Vera # DN10893 Chuong, Robert # DN23944 Espinosa-Batista, # HAD80 Antony, Archana NPI: 1386202984 LIC: DN24131 NPI: 1558369678 LIC: DN10893 Claudia General Dentist servicing as: # DN24055 Lodhi, Hafsa NPI: 1447747449 LIC: DN23944 POLK COUNTY Pediatric Dentistry NPI: 1588023584 LIC: DN24055 # DN16346 Gomara, Denise NPI: 1851607766 LIC: HAD80 General Dentist servicing as: # 24529 Moini, Marshall DENTIST # DN23942 Cameron, Casey Pediatric Dentistry NPI: 1437700937 LIC: 24529 NPI: 1548758147 LIC: DN23942 NPI: 1497887863 LIC: DN16346 # CHC7919 # DN23402 Montenegro, Christian # HAD79 Cocchieri, Richard Central Florida Health Care # DN20914 Hackstie, Joseph NPI: 1144714445 LIC: DN23402 General Dentist servicing as: NPI: 1932508405 LIC: DN20914 109 W. Wall St Pediatric Dentistry # DN23652 Ospina, Luz Frostproof, FL 33843 # DN18154 Mckenzie, Karen NPI: 1578685491 LIC: HAD79 General Dentist servicing as: (863) 635-4891 General Dentist servicing as: Oral Surgery # HAD92 Coello, Marla Special Needs: Yes Pediatric Dentistry NPI: 1881181501 LIC: DN23652 NPI: 1891833620 LIC: HAD92 English, Spanish, Creoles and NPI: 1821286287 LIC: DN18154 # DN23021 Riboul, Sandrine Pidgins English-based(other), # DN12668 Congote, Luis # HAD33 Modaff, Michelle NPI: 1609227057 LIC: DN23021 French General Dentist servicing as: NPI: 1497768295 LIC: HAD33 CERTIFICATIONS: M-T 7:30 am - 5:30 pm Pediatric Dentistry • Inhalation Sedation W-F 7:30 am - 5:30 pm # DN21596 Nagib, Marie Claire NPI: 1679774426 LIC: DN12668

# DN23007 Rivera, Lina # DN22773 Aiyede, Onize NPI: 1225414907 LIC: DN21596 # DN13255 Cooper, Angela NPI: 1760908743 LIC: DN23007 General Dentist servicing as: # DN22245 Rubin, Joslyn General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry # DN20475 Santiago, Germaine General Dentist servicing as: NPI: 1306295712 LIC: DN22773 Pediatric Dentistry NPI: 1912994914 LIC: DN13255 NPI: 1922341460 LIC: DN20475

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 77 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN23944 Espinosa-Batista, NPI: 1306295712 LIC: DN22773 # DN22245 Rubin, Joslyn NPI: 1851607766 LIC: HAD80 Claudia # HAD80 Antony, Archana General Dentist servicing as: # DN23942 Cameron, Casey NPI: 1447747449 LIC: DN23944 General Dentist servicing as: Pediatric Dentistry NPI: 1548758147 LIC: DN23942 # DN16346 Gomara, Denise Pediatric Dentistry NPI: 1861940850 LIC: DN22245 # HAD79 Cocchieri, Richard General Dentist servicing as: NPI: 1851607766 LIC: HAD80 # DN6990 Seifert, Thomas General Dentist servicing as: Pediatric Dentistry # DN23942 Cameron, Casey General Dentist servicing as: Pediatric Dentistry NPI: 1497887863 LIC: DN16346 NPI: 1548758147 LIC: DN23942 Pediatric Dentistry NPI: 1578685491 LIC: HAD79 # DN20914 Hackstie, Joseph NPI: 1255654232 LIC: DN6990 # HAD79 Cocchieri, Richard # HAD92 Coello, Marla NPI: 1932508405 LIC: DN20914 # DN15069 Suri, Niki General Dentist servicing as: NPI: 1891833620 LIC: HAD92 # DN18154 Mckenzie, Karen Pediatric Dentistry NPI: 1316129182 LIC: DN15069 # DN12668 Congote, Luis General Dentist servicing as: NPI: 1578685491 LIC: HAD79 # FQHC020824 General Dentist servicing as: Pediatric Dentistry # HAD92 Coello, Marla Pediatric Dentistry NPI: 1821286287 LIC: DN18154 Central Florida Health Care, NPI: 1891833620 LIC: HAD92 NPI: 1679774426 LIC: DN12668 Inc # HAD33 Modaff, Michelle # DN12668 Congote, Luis 601 S. Florida Ave, Ste 6 # DN13255 Cooper, Angela NPI: 1497768295 LIC: HAD33 General Dentist servicing as: Lakeland, FL 33801 General Dentist servicing as: # DN21596 Nagib, Marie Claire Pediatric Dentistry (866) 234-8534 Pediatric Dentistry NPI: 1225414907 LIC: DN21596 NPI: 1679774426 LIC: DN12668 Special Needs: Yes NPI: 1912994914 LIC: DN13255

# DN22245 Rubin, Joslyn # DN13255 Cooper, Angela English, Spanish, Creoles and # DN23944 Espinosa-Batista, Pidgins French-based(other) General Dentist servicing as: General Dentist servicing as: Claudia M-T 8am - 5pm Pediatric Dentistry Pediatric Dentistry NPI: 1447747449 LIC: DN23944 NPI: 1912994914 LIC: DN13255 W-F 8am - 5pm NPI: 1861940850 LIC: DN22245 # DN16346 Gomara, Denise # DN24008 Pettit, Karen # DN6990 Seifert, Thomas # DN23944 Espinosa-Batista, General Dentist servicing as: NPI: 1285123414 LIC: DN24008 General Dentist servicing as: Claudia Pediatric Dentistry Pediatric Dentistry NPI: 1447747449 LIC: DN23944 NPI: 1497887863 LIC: DN16346 # FQHC021227 NPI: 1255654232 LIC: DN6990 # DN16346 Gomara, Denise # DN20914 Hackstie, Joseph Central Florida Health Care, # DN15069 Suri, Niki General Dentist servicing as: NPI: 1932508405 LIC: DN20914 Inc NPI: 1316129182 LIC: DN15069 Pediatric Dentistry 705 Ingraham Ave # DN18154 Mckenzie, Karen NPI: 1497887863 LIC: DN16346 Haines City, FL 33844 General Dentist servicing as: # FQHC123626 # DN20914 Hackstie, Joseph (863) 438-6900 Pediatric Dentistry Central Florida Health Care NPI: 1932508405 LIC: DN20914 Special Needs: Yes NPI: 1821286287 LIC: DN18154 - Lakeland Hills Dental # DN18154 Mckenzie, Karen English, Spanish, Creoles and # HAD33 Modaff, Michelle 1417 Lakeland Hills Blvd Ste 101 General Dentist servicing as: Pidgins English-based(other) NPI: 1497768295 LIC: HAD33 Lakeland, FL 33805 Pediatric Dentistry M-T 7:30 am - 6pm (866) 234-8534 # DN21596 Nagib, Marie Claire NPI: 1821286287 LIC: DN18154 W-Th 7:30 am - 6pm Special Needs: Yes NPI: 1225414907 LIC: DN21596 # HAD33 Modaff, Michelle # DN22773 Aiyede, Onize English, Spanish General Dentist servicing as: # DN22245 Rubin, Joslyn M-T 8am - 5pm NPI: 1497768295 LIC: HAD33 Pediatric Dentistry General Dentist servicing as: W-F 8am - 5pm # DN24360 Moncayo, Valerie NPI: 1306295712 LIC: DN22773 Pediatric Dentistry # DN22773 Aiyede, Onize NPI: 1356993380 LIC: DN24360 NPI: 1861940850 LIC: DN22245 # HAD80 Antony, Archana General Dentist servicing as: # DN21596 Nagib, Marie Claire General Dentist servicing as: # DN6990 Seifert, Thomas Pediatric Dentistry NPI: 1225414907 LIC: DN21596 Pediatric 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 78 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

General Dentist servicing as: # DN23944 Espinosa-Batista, NPI: 1306295712 LIC: DN22773 General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry Claudia # HAD80 Antony, Archana* NPI: 1255654232 LIC: DN6990 NPI: 1861940850 LIC: DN22245 NPI: 1447747449 LIC: DN23944 General Dentist servicing as: # DN15069 Suri, Niki # DN16346 Gomara, Denise Pediatric Dentistry # DN6990 Seifert, Thomas* NPI: 1316129182 LIC: DN15069 General Dentist servicing as: NPI: 1851607766 LIC: HAD80 General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry # DN23942 Cameron, Casey* # FQHC011909 NPI: 1497887863 LIC: DN16346 NPI: 1255654232 LIC: DN6990 NPI: 1548758147 LIC: DN23942 Central Florida Health Care, # DN20914 Hackstie, Joseph # DN15069 Suri, Niki* # HAD79 Cocchieri, Richard* Inc. NPI: 1932508405 LIC: DN20914 NPI: 1316129182 LIC: DN15069 1514 1St St North General Dentist servicing as: Pediatric Dentistry Winter Haven, FL 33881 # DN18154 Mckenzie, Karen # FQHC015864 NPI: 1578685491 LIC: HAD79 (866) 234-8534 General Dentist servicing as: Central Florida Health Care, Pediatric Dentistry # HAD92 Coello, Marla* Special Needs: Yes Inc. NPI: 1821286287 LIC: DN18154 English, Spanish, Creoles and NPI: 1891833620 LIC: HAD92 201 Magnolia Ave Sw Pidgins French-based(other) # DN24360 Moncayo, Valerie # DN12668 Congote, Luis* Winter Haven, FL 33880 M-T 7:30 am - 6pm NPI: 1356993380 LIC: DN24360 General Dentist servicing as: www.cfhconline.org W-Th 7:30 am - 6pm # DN21596 Nagib, Marie Claire Pediatric Dentistry (866) 234-8534 # DN22773 Aiyede, Onize Special Needs: Yes NPI: 1225414907 LIC: DN21596 NPI: 1679774426 LIC: DN12668 General Dentist servicing as: English, Spanish, Creoles and # DN22245 # DN13255 Cooper, Angela* Pediatric Dentistry Rubin, Joslyn Pidgins French-based(other) General Dentist servicing as: NPI: 1306295712 LIC: DN22773 General Dentist servicing as: M-T 7:30 am - 5pm Pediatric Dentistry Pediatric Dentistry # HAD80 Antony, Archana W-F 7:30 am - 5pm NPI: 1861940850 LIC: DN22245 NPI: 1912994914 LIC: DN13255 General Dentist servicing as: # DN22773 Aiyede, Onize # DN23944 Espinosa-Batista, Pediatric Dentistry # DN6990 Seifert, Thomas General Dentist servicing as: Claudia* NPI: 1851607766 LIC: HAD80 General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry NPI: 1447747449 LIC: DN23944 # DN23942 Cameron, Casey NPI: 1306295712 LIC: DN22773 NPI: 1255654232 LIC: DN6990 # DN16346 Gomara, Denise* NPI: 1548758147 LIC: DN23942 # HAD80 Antony, Archana General Dentist servicing as: # DN15069 Suri, Niki General Dentist servicing as: # HAD79 Cocchieri, Richard Pediatric Dentistry NPI: 1316129182 LIC: DN15069 Pediatric Dentistry General Dentist servicing as: NPI: 1497887863 LIC: DN16346 NPI: 1851607766 LIC: HAD80 Pediatric Dentistry # FQHC012686 # DN20914 Hackstie, Joseph* NPI: 1578685491 LIC: HAD79 # DN23942 Cameron, Casey Central Florida Health Care, NPI: 1932508405 LIC: DN20914 # HAD92 Coello, Marla NPI: 1548758147 LIC: DN23942 Inc. # DN18154 Mckenzie, Karen* NPI: 1891833620 LIC: HAD92 106 Nw 9Th Ave # HAD79 Cocchieri, Richard General Dentist servicing as: General Dentist servicing as: # DN12668 Congote, Luis Mulberry, FL 33860 Pediatric Dentistry (863) 425-6200 Pediatric Dentistry General Dentist servicing as: NPI: 1821286287 LIC: DN18154 NPI: 1578685491 LIC: HAD79 Pediatric Dentistry Special Needs: Yes # HAD33 Modaff, Michelle* NPI: 1679774426 LIC: DN12668 English, Spanish # HAD92 Coello, Marla M-T 7:30 am - 6pm NPI: 1497768295 LIC: HAD33 # DN13255 Cooper, Angela NPI: 1891833620 LIC: HAD92 W-F 7:30 am - 6pm # DN21596 Nagib, Marie Claire* General Dentist servicing as: # DN12668 Congote, Luis Pediatric Dentistry # DN22773 Aiyede, Onize NPI: 1225414907 LIC: DN21596 General Dentist servicing as: NPI: 1912994914 LIC: DN13255 General Dentist servicing as: # DN22245 Rubin, Joslyn* Pediatric Dentistry Pediatric Dentistry NPI: 1679774426 LIC: DN12668

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 79 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN13255 Cooper, Angela W-Th 8:30 am - 4pm # DN11009 Ebner, Stephen M-T 8am - 5pm General Dentist servicing as: # DN17074 Mueller III, William* NPI: 1578652442 LIC: DN11009 W-F 8am - 5pm Pediatric Dentistry General Dentist servicing as: CERTIFICATIONS: # DN11009 Ebner, Stephen NPI: 1912994914 LIC: DN13255 Pediatric Dentistry • Inhalation Sedation NPI: 1578652442 LIC: DN11009 # DN23944 Espinosa-Batista, NPI: 1164574679 LIC: DN17074 # DN15480 Rodriguez, Ana CERTIFICATIONS: Claudia # DN14392 Walding III, Stephen* NPI: 1184835985 LIC: DN15480 • Inhalation Sedation NPI: 1447747449 LIC: DN23944 General Dentist servicing as: CERTIFICATIONS: # DN15480 Rodriguez, Ana Pediatric Dentistry • Inhalation Sedation # DN16346 Gomara, Denise NPI: 1184835985 LIC: DN15480 NPI: 1023160637 LIC: DN14392 # DN19400 Santos, Luis General Dentist servicing as: CERTIFICATIONS: Pediatric Dentistry NPI: 1821152232 LIC: DN19400 • Inhalation Sedation # CHC10104 NPI: 1497887863 LIC: DN16346 CERTIFICATIONS: # DN19400 Santos, Luis DOH - Polk County Health • Inhalation Sedation # DN20914 Hackstie, Joseph NPI: 1821152232 LIC: DN19400 Department CERTIFICATIONS: NPI: 1932508405 LIC: DN20914 1805 Hobbs Road # CHC10106 • Inhalation Sedation # DN18154 Mckenzie, Karen Auburndale, FL 33823 DOH - Polk County Health General Dentist servicing as: (863) 519-7910 Department # 007727 Pediatric Dentistry Special Needs: Yes 2090 E. Clower St Mulberry Dental Care, Inc NPI: 1821286287 LIC: DN18154 English, Spanish, Sign Languages Bartow, FL 33830 105 N. Church Ave M-T 8am - 5pm # HAD33 Modaff, Michelle (863) 534-7258 Mulberry, FL 33860 W-F 8am - 5pm Special Needs: Yes NPI: 1497768295 LIC: HAD33 (863) 869-8888 # DN11009 Ebner, Stephen Spanish, English Special Needs: Yes # DN24360 Moncayo, Valerie NPI: 1578652442 LIC: DN11009 # DN11009 Ebner, Stephen English, Farsi, French, Persian NPI: 1356993380 LIC: DN24360 CERTIFICATIONS: NPI: 1578652442 LIC: DN11009 (T), Spanish # DN21596 Nagib, Marie Claire • Inhalation Sedation CERTIFICATIONS: M-T 8am - 4:30 pm NPI: 1225414907 LIC: DN21596 # DN15480 Rodriguez, Ana • Inhalation Sedation W-Th 8am - 4:30 pm # DN22245 Rubin, Joslyn NPI: 1184835985 LIC: DN15480 # DN15480 Rodriguez, Ana # DN13817 Farzaneh, Masoud General Dentist servicing as: CERTIFICATIONS: NPI: 1184835985 LIC: DN15480 NPI: 1669544540 LIC: DN13817 Pediatric Dentistry • Inhalation Sedation CERTIFICATIONS: # DN13663 Shafii, Fariba NPI: 1861940850 LIC: DN22245 • Inhalation Sedation # DN19400 Santos, Luis NPI: 1558433490 LIC: DN13663 # DN6990 Seifert, Thomas NPI: 1821152232 LIC: DN19400 # DN19400 Santos, Luis General Dentist servicing as: CERTIFICATIONS: NPI: 1821152232 LIC: DN19400 ORAL SURGEON Pediatric Dentistry • Inhalation Sedation CERTIFICATIONS: NPI: 1255654232 LIC: DN6990 • Inhalation Sedation # 022551 # CHC10105 # DN15069 Suri, Niki Tampa Bay Institute of Oral DOH - Polk County Health # CHC10107 NPI: 1316129182 LIC: DN15069 Surgery & Dental Implants DOH - Polk County Health Department 1301 Grasslands Blvd, Ste 200 # 012845 1700 Baker Ave East Department Lakeland, FL 33803 Haines City, FL 33844 Dental Associates of Bartow 3241 Lakeland Hills Blvd https://tampabayos.com (863) 519-7910 Lakeland, FL 33805 (863) 648-6555 2090 Flamingo Drive East Special Needs: Yes (863) 519-7910 Special Needs: Yes Bartow, FL 33830 English, Spanish Special Needs: Yes (863) 614-1801 English, Spanish M-T 8am - 5pm English, Spanish, Creoles and Special Needs: Yes M-T 7am - 4pm W-F 8am - 5pm Pidgins French-based(other) English W-Th 7am - 4pm

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 80 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

# DN18163FL Aves, Renato # DN16033FL Nguyen, Daniel (904) 824-3322 # DN6163 Strawn, James* Special Needs: Yes NPI: 1336322650 LIC: DN18163FL NPI: 1134238892 LIC: DN16033FL NPI: 1902836851 LIC: DN6163 CERTIFICATIONS: English, Spanish # DN20946FL Nguyen, David • Inhalation Sedation M-T 8am - 7pm # FQHC020245 NPI: 1811398423 LIC: DN20946FL • General Anesthesia # DN25141FL Le, Lynn Florida Community Health # DN12941 Pairot, Alfredo # DN23977 Elmohd, Tarik NPI: 1336750470 LIC: DN25141FL Centers, Inc. NPI: 1538556329 LIC: DN23977 General Dentist servicing as: # DN20873 Lopez, Melvin 1505 Delaware Ave Pediatric Dentistry # DN21438 Kalsow, Oleg General Dentist servicing as: Fort Pierce, FL 34950 NPI: 1932174448 LIC: DN12941 NPI: 1275951972 LIC: DN21438 Pediatric Dentistry www.fchcinc.org # DN20886 Wells, Rachelle NPI: 1689081242 LIC: DN20873 (772) 461-1402 # DN19378 Samaniego, Juan NPI: 1588858286 LIC: DN20886 Special Needs: Yes NPI: 1467692129 LIC: DN19378 # DN16033FL Nguyen, Daniel CERTIFICATIONS: English, Spanish, Creoles and NPI: 1134238892 LIC: DN16033FL CERTIFICATIONS: • Inhalation Sedation Pidgins (other) • Inhalation Sedation # DN20946FL Nguyen, David M 8am - 6pm, T 8am - 8pm • General Anesthesia # CHC10218 NPI: 1811398423 LIC: DN20946FL W-F 8am - 8pm # DN16473 Walcott, Sean DOH - Putnam County # DN12941 Pairot, Alfredo # DN20720 Blackwood, Alberto NPI: 1841250743 LIC: DN16473 Health Department General Dentist servicing as: NPI: 1487057303 LIC: DN20720 CERTIFICATIONS: 2801 Kennedy Street Pediatric Dentistry # DN13607 Morales, Carlos • General Anesthesia Palatka, FL 32177 NPI: 1932174448 LIC: DN12941 (386) 326-3336 NPI: 1457310559 LIC: DN13607 PUTNAM COUNTY # DN20886 Wells, Rachelle Special Needs: Yes # DN14000 Naryshkin, George NPI: 1588858286 LIC: DN20886 DENTIST English, Spanish, Czech, German, NPI: 1730395773 LIC: DN14000 Hungarian, Slovak CERTIFICATIONS: # DN23400 Pham, Emily M-T 8am - 5pm • Inhalation Sedation # FQHC010441 W 8am - 5pm, Th 9am - 5pm, F NPI: 1851947568 LIC: DN23400 Aza Health SAINT LUCIE COUNTY 8am - 5pm # DN17356 Saint Amand, Lynn 2503 President Street # DN11663 Bridges, Catherine DENTIST NPI: 1972655587 LIC: DN17356 Palatka, FL 32177 NPI: 1659309821 LIC: DN11663 # DN13771 Sanchez, Armando www.azahealth.org # DN11105 Krajcovic, Leslie # CHC015266 (386) 328-7638 NPI: 1992764930 LIC: DN13771 Special Needs: Yes NPI: 1851588057 LIC: DN11105 DOH - Saint Lucie County # DN13207 Zayas, Alida Health Department English, Spanish, Vietnamese # DN11385 Traul Jr., Robert NPI: 1639148968 LIC: DN13207 714 Ave C M-T 8am - 7pm General Dentist servicing as: W-Th 8am - 7pm Pediatric Dentistry Fort Pierce, FL 34950 # 014579 (772) 462-3874 # DN15770 Halady, Pratima NPI: 1982734257 LIC: DN11385 Happy Smiles Special Needs: Yes General Dentist servicing as: 1100 Sw St. Lucie Blvd, Ste 206 SAINT JOHNS COUNTY English, Spanish, Creoles and Pediatric Dentistry Port Saint Lucie, FL 34986 Pidgins (other), French NPI: 1720256811 LIC: DN15770 [email protected] DENTIST # DN14245 Ahmad, Haleemah* # DN25141FL Le, Lynn (772) 807-1451 NPI: 1437240835 LIC: DN14245 Special Needs: Yes NPI: 1336750470 LIC: DN25141FL # FQHC016587 # HAD102 McKenzie, JaVon* English, Russian, Creoles and # DN20873 Lopez, Melvin Aza Health NPI: 1073513172 LIC: HAD102 Pidgins English-based(other), General Dentist servicing as: 250 State Rd 207 Hebrew, Spanish # DN9911 Singh, Rajinder* Pediatric Dentistry Saint Augustine, FL 32084 M-T 9am - 5pm NPI: 1689081242 LIC: DN20873 www.azahealth.org NPI: 1154527208 LIC: DN9911

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 81 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

W-F 9am - 5pm SARASOTA COUNTY # DN24525 Curd, Francis # DN16242 Misischia, William* # DN23633 Andrade, Emily* NPI: 1649395542 LIC: DN24525 NPI: 1619199973 LIC: DN16242 NPI: 1407335409 LIC: DN23633 DENTIST # DN21483 DeVilliers, Patricia CERTIFICATIONS: • Inhalation Sedation # DN20845 Bradley, Alijah* NPI: 1669568861 LIC: DN21483 # 015890 NPI: 1003224148 LIC: DN20845 CERTIFICATIONS: # 013443 Beneva Dental Care • Inhalation Sedation # DN10457FL Broggi, Edward* F.A. Skordas, DDS, MS, PL 5917 S. Beneva Road # DN23710 Houston, James NPI: 1215955190 LIC: DN10457FL 7129 Curtiss Ave, Ste #2 Sarasota, FL 34238 NPI: 1972661734 LIC: DN23710 # DN25701 Ghods, Shawn* Sarasota, FL 34231 (941) 924-2939 CERTIFICATIONS: (941) 922-8811 NPI: 1174100903 LIC: DN25701 Special Needs: No • Inhalation Sedation English, Spanish Special Needs: Yes # DN25050 Gross, Steven* # DN14316 Jenkins, James M-T 8am - 4pm English, Japanese NPI: 1063029122 LIC: DN25050 NPI: 1861701906 LIC: DN14316 M-T 8:30 am - 6pm # DN10922 Jimenez, Baltasar # DN23454FL Nguyen, Michelle* CERTIFICATIONS: W-F 8:30 am - 6pm NPI: 1104031442 LIC: DN10922 • Inhalation Sedation General Dentist servicing as: # DN13645 Skordas, Fotios Endodontics CERTIFICATIONS: # DN16242 Misischia, William • Inhalation Sedation NPI: 1124308812 LIC: DN13645 NPI: 1033603733 LIC: DN23454FL NPI: 1619199973 LIC: DN16242 CERTIFICATIONS: # EV789893 CERTIFICATIONS: # FQHC930324 • Inhalation Sedation • Inhalation Sedation CAN Community Health, Inc. Montiel Dental Care PA # DN13556 Schreiber, Page* 1231 N Tuttle Ave # FQHC019490 3920 Bee Ridge Rd Bldg B Ste B General Dentist servicing as: Sarasota, FL 34237 Sarasota, FL 34233 Endodontics CenterPlace Health Inc. (941) 366-0314 (941) 487-8824 NPI: 1023280807 LIC: DN13556 2200 Ringling Blvd Special Needs: Yes Special Needs: Yes # DN24429FL Shahriari, Sarasota, FL 34237 English, Spanish English, Spanish (941) 529-0200 Varahram* M-T 9am - 4pm M-T 8am - 5pm Special Needs: No General Dentist servicing as: W 8am - 5pm, Th 8am - 6pm, F W-Th 9am - 4pm Endodontics English, Spanish 8:30 am - 12:30 pm # DN23640 Moreno Montiel, Yuliet NPI: 1952954778 LIC: DN24429FL M-T 7am - 5pm # DN14864 Henry, Stephen W-F 7am - 5pm General Dentist servicing as: # DN16481 Zadov, Marianna* NPI: 1851455117 LIC: DN14864 Endodontics # DN24525 Curd, Francis* NPI: 1104903301 LIC: DN16481 NPI: 1841786647 LIC: DN23640 # DN20641 Makary, Sara CERTIFICATIONS: NPI: 1649395542 LIC: DN24525 NPI: 1851704654 LIC: DN20641 • Inhalation Sedation # DN21483 DeVilliers, Patricia* # 022617 NPI: 1669568861 LIC: DN21483 Velasquez-Pierce Family PERIODONTICS # FQHC019492 CERTIFICATIONS: Dentistry Inc CenterPlace Health Inc # DN23115 Mendoza, Juan* • Inhalation Sedation 1872 S. Tamiami Trail Ste E 1750 17Th St. Building E NPI: 1821326430 LIC: DN23115 # DN23710 Houston, James* Venice, FL 34293 Sarasota, FL 34236 CERTIFICATIONS: NPI: 1972661734 LIC: DN23710 (941) 497-4997 www.centerplacehealth.org Special Needs: Yes • Inhalation Sedation CERTIFICATIONS: (941) 529-0100 # DN11699 Simon, David* • Inhalation Sedation English, Spanish Special Needs: Yes M-T 8:30 am - 4pm NPI 1508303587 LIC: DN11699 DN14316 : English, Spanish # Jenkins, James* # DN21607 Velasquez-Pierce, CERTIFICATIONS: M-T 7am - 4pm NPI: 1861701906 LIC: DN14316 • Oral / Enteral Sedation Ximena W-F 7am - 4pm CERTIFICATIONS: • Inhalation Sedation NPI: 1548606874 LIC: DN21607

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 82 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

• Inhalation Sedation NPI: 1922341460 LIC: DN20475 SEMINOLE COUNTY # 012552 # DN24313FL Evans, Mana # DN21066 Uzunova-Dimova, Prem K. Kathuria, PA DENTIST NPI: 1750818712 LIC: DN24313FL Kalina 1670 S. Hwy 17-92 # DN24375FL Gaton Molina, Sarah General Dentist servicing as: Pediatric Dentistry Longwood, FL 32750 # 009751 NPI: 1538713979 LIC: DN24375FL NPI: 1245540947 LIC: DN21066 (407) 339-4700 Altamonte Mall Dental # DN17335FL Guilarte, Rhona Special Needs: Yes 451 Altamonte Dr Ste, 1279 NPI: 1619956323 LIC: DN17335FL # CHC10026 English, Arabic, Hindi, Japanese, Altamonte Springs, FL 32701 Spanish # DN23847 Khan, Adiba DOH - Seminole County (407) 261-0201 NPI: 1649638172 LIC: DN23847 Health Department # DN8196 Kathuria, Prem* Special Needs: Yes 400 W. Airport Blvd NPI: 1336300763 LIC: DN8196 English, Russian, Spanish # DN22197 Khatib, Adel Sanford, FL 32773 M-T 11am - 6pm General Dentist servicing as: www.seminolecohealth.com ORAL SURGEON W-F 11am - 6pm Endodontics (407) 665-3346 NPI: 1235582503 LIC: DN22197 # DN22246 Antezana, Mauricio Special Needs: Yes # 021444 General Dentist servicing as: # DN16377 Krasnov, Rostislav English, Spanish, Hindi Oral & Facial Surgery of Pediatric Dentistry NPI: 1942267935 LIC: DN16377 M-T 8am - 5pm Florida, Inc. NPI: 1063876399 LIC: DN22246 # DN24131 Krupnov, Vera W-F 8am - 5pm 924 Williston Park Pt. # DN21079 Arnedo, Johanna NPI: 1386202984 LIC: DN24131 # DN12474 Barinas, Norma Lake Mary, FL 32746 General Dentist servicing as: (407) 624-5113 # DN20101 Licina, Zeljka General Dentist servicing as: Pediatric Dentistry Pediatric Dentistry Special Needs: Yes NPI: 1013263292 LIC: DN20101 NPI: 1104213909 LIC: DN21079 NPI: 1780690123 LIC: DN12474 English CERTIFICATIONS: # DN24055 Lodhi, Hafsa M-T 7:30 am - 4:30 pm # DN8976 Hanna, Nabil • Inhalation Sedation NPI: 1588023584 LIC: DN24055 W-Th 7:30 am - 4:30 pm NPI: 1215235924 LIC: DN8976 # DN17412 Atkinson, William # DN19470 Maniglia, Marielba # DN15621 Azizi, Abdul General Dentist servicing as: # HAD54 James, Frederick NPI: 1063793644 LIC: DN19470 NPI: 1053329995 LIC: DN15621 Pediatric Dentistry NPI: 1861510984 LIC: HAD54 # 24529 CERTIFICATIONS: NPI: 1942360862 LIC: DN17412 Moini, Marshall # DN18472 Koenig, Hans • General Anesthesia CERTIFICATIONS: NPI: 1437700937 LIC: 24529 NPI: 1760535934 LIC: DN18472 # DN20457FL Bell, Michael • Inhalation Sedation # DN23402 Montenegro, Christian CERTIFICATIONS: NPI: 1932462181 LIC: DN20457FL # DN17123 Bravo, Raquel NPI: 1144714445 LIC: DN23402 • Inhalation Sedation

NPI: 1538312525 LIC: DN17123 # DN23652 Ospina, Luz SUMTER COUNTY # 013496 # DN24546 Burns, Devin General Dentist servicing as: Kush Dental LLC DENTIST NPI: 1699221556 LIC: DN24546 Oral Surgery NPI: 1881181501 LIC: DN23652 1012 State Rd 436 # DN21812 Cabrera, Rene Casselberry, FL 32707 # 015271 General Dentist servicing as: # DN23021 Riboul, Sandrine (407) 636-7602 Central FL Dental Pediatric Dentistry NPI: 1609227057 LIC: DN23021 Special Needs: No Associates, LLC NPI: 1518313675 LIC: DN21812 CERTIFICATIONS: English, Spanish 11905 N Us Highway 301 • Inhalation Sedation # DN7894 Cullen, William W 8am - 6pm, Th 9am - 4pm, F Oxford, FL 34484 # DN23007 Rivera, Lina General Dentist servicing as: 10am - 2pm (352) 748-9688 Pediatric Dentistry NPI: 1760908743 LIC: DN23007 # DN12237 Figaro, Mark Special Needs: Yes NPI: 1013110535 LIC: DN7894 # DN20475 Santiago, Germaine NPI: 1952516965 LIC: DN12237 English, Spanish CERTIFICATIONS: M-T 9am - 5pm

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 83 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

W-F 9am - 5pm General Dentist servicing as: W-F 10am - 5:30 pm Daytona Pediatric Dentistry Pediatric Dentistry # DN14975 Constantin, Serioja # DN16520 Ballet, Lourdes @ Halifax Hospital NPI: 1023196169 LIC: DN14803 NPI: 1225219819 LIC: DN14975 General Dentist servicing as: 303 N. Clyde Morris Blvd CERTIFICATIONS: Pediatric Dentistry Daytona Beach, FL 32114 # DN12237 Figaro, Mark • Inhalation Sedation NPI: 1255517850 LIC: DN16520 (386) 304-2677 NPI: 1952516965 LIC: DN12237 TAYLOR COUNTY Special Needs: No # DN13227 Johary, Carlos # CHC10220 English, Arabic, Portuguese, NPI: 1336338755 LIC: DN13227 DENTIST DOH - Volusia County Health Spanish M-T 8am - 5pm # DN25500FL Santana, Liliana Department # FQHC011463 1845 Holsonback Drive W-F 8am - 5pm NPI: 1750998209 LIC: DN25500FL Taylor Dental Center Daytona Beach, FL 32117 # DN24580 Greene, Stephen* (386) 274-0896 # FQHC10255 616 S. Jefferson St NPI: 1194113373 LIC: DN24580 Special Needs: Yes Langley Health Services Perry, FL 32347 English, Spanish, Tagalog WAKULLA COUNTY 1389 S. U.S. Hwy 301 http://www.northfloridamedicalc W-F 8am - 5pm Sumterville, FL 33585 enters.org DENTIST (850) 223-2578 # DN19698 Aliev, Ulan (352) 793-5900 Special Needs: Yes NPI 1972866994 LIC: DN19698 Special Needs: Yes : # CHC013453 English English, Spanish # DN15461 Nguyen, Christine DOH - Wakulla County M-T 8am - 5pm M-T 8am - 5pm NPI: 1306988050 LIC: DN15461 W-F 8am - 5pm Health Department W-F 8am - 5pm # DN12760 Nguyen, Huong 48 Oak Street # DN21203 Chou, Victor # DN19878 Clinton, Edna NPI 1720350572 LIC: DN12760 Crawfordville, FL 32327 General Dentist servicing as: : General Dentist servicing as: (850) 926-0400 # DN15309 Orlando, Denise Pediatric Dentistry NPI: 1558741249 LIC: DN21203 Special Needs: Yes NPI: 1700819349 LIC: DN15309 NPI: 1376853929 LIC: DN19878 # DN24185 Durham, Dominique English, Spanish CERTIFICATIONS: General Dentist servicing as: # DN15310 Orlando, Michael M-T 8am - 5pm • Inhalation Sedation W-F 8am - 5pm NPI: 1053972257 LIC: DN24185 NPI: 1174557870 LIC: DN15310 # DN24579FL Johnson, Christina # DN11663 Bridges, Catherine # DN24876FL Soekirman, Lauren NPI: 1578104063 LIC: DN24579FL # FQHC020653 General Dentist servicing as: NPI: 1659309821 LIC: DN11663 # DN23356 Lutes, Meaghan Family Health Source NPI: 1508489238 LIC: DN24876FL # DN11385 Traul Jr., Robert 1205 Woodland Blvd, Ste 5 NPI: 1760974554 LIC: DN23356 General Dentist servicing as: Deland, FL 32720 # DN20142 Matthews, Irina VOLUSIA COUNTY Pediatric Dentistry (386) 888-4911 NPI: 1891135331 LIC: DN20142 NPI: 1982734257 LIC: DN11385 DENTIST Special Needs: No # DN21667 Pirie, Edward English, Spanish WALTON COUNTY NPI: 1255705752 LIC: DN21667 # 011119 M-T 8am - 5:30 pm W-Th 8am - 5:30 pm DENTIST # DN15250 Vavruska, Julie Ballet Dental Care General Dentist servicing as: 1857 Providence Blvd, Ste 200 # DN12417 Torres, Leonel # 012992 Pediatric Dentistry Deltona, FL 32725 NPI: 1942411962 LIC: DN12417 LECOM School of Dental NPI: 1992798649 LIC: DN15250 (321) 283-2850 CERTIFICATIONS: Special Needs: Yes PEDIATRIC DENTISTRY Medicine - Dental Offices 101 Lecom Way • Inhalation Sedation English, Spanish Defuniak Springs, FL 32435 # DN14803 Worthy, Michele M-T 10am - 5:30 pm # 011282-HOSP3 (850) 951-0200

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 84 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

Special Needs: Yes General Dentist servicing as: M-T 7am - 5:30 pm

English NPI: 1699705434 LIC: DN21660 # DN18661 Whitford, Drew M-T 7am - 7pm # DN23084 Santos, Iris NPI: 1851527303 LIC: DN18661 W-F 7am - 7pm NPI: 1487875233 LIC: DN23084 CERTIFICATIONS: # DN6824 Henry, Dan • Inhalation Sedation # HAD69 Smith, Amy NPI: 1932279122 LIC: DN6824 NPI: 1831209899 LIC: HAD69 CERTIFICATIONS: • Inhalation Sedation # DN18668 Van Dyke, # DN14491 Turner, Helen Kanyaratana NPI: 1518049717 LIC: DN14491 NPI: 1003122656 LIC: DN18668

# DN6012 Zieman, Stephen # HAD65 Wilhite, Rhonda General Dentist servicing as: NPI: 1407100720 LIC: DN6012 NPI: 1952496341 LIC: HAD65 # FQHC010686 # DN22573 Williams, Sean PanCare of Florida, Inc. NPI: 1306376512 LIC: DN22573 479 E. Hwy 20 Freeport, FL 32439 PERIODONTICS (850) 880-6568 Special Needs: No # 012992 English LECOM School of Dental M-T 8am - 5pm Medicine - Dental Offices W-F 8am - 5pm 101 Lecom Way # DN10365FL Barry, Steven Defuniak Springs, FL 32435 NPI: 1497826531 LIC: DN10365FL (850) 951-0200 Special Needs: Yes # DN19128 Claussen, Meghann English NPI: 1336454651 LIC: DN19128 M-T 7am - 7pm # DN25097 Haynam, Eric W-F 7am - 7pm

NPI: 1043688831 LIC: DN25097 # DN4547 Couch, Deck # DN13094 Hudon, Richard NPI: 1417190950 LIC: DN4547 NPI: 1245336031 LIC: DN13094 WASHINGTON COUNTY # DN21740 Moffa, Michelle General Dentist servicing as: DENTIST NPI: 1841277407 LIC: DN21740 # CHC015270 # DN19745 Norton, Andrew DOH - Washington County NPI: 1861754020 LIC: DN19745 Health Department # DN18871 Pate, Sheena 1338 South Blvd General Dentist servicing as: Chipley, FL 32428 Pediatric Dentistry (850) 638-6240 NPI: 1215255880 LIC: DN18871 Special Needs: Yes # DN21660 Piorkowski, Gary 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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 85 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020) FLORIDA MEDICAID ADULT PROVIDER DIRECTORY / DIRECTORIO DE PROVEEDORES

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

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. August, 2021 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. Wheelchair access / Acceso para personas en silla de ruedas. * Page 86 of 86 Weekend and Holiday availability by appointment only / Disponibilidad de fines de semana y días festivos solo con cita previa. 08/24/2021 v2(2020)