Individual
DR. LARISA IGOREVNA MACEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
26831 S TAMIAMI TRL UNIT 48, BONITA SPRINGS, FL 34134-7828
(239) 948-3200
Mailing address
2411 FRYER PT, FORT LAUDERDALE, FL 33305-2722
(312) 826-9218
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2021022228
MO
Other
Enumeration date
07/13/2021
Last updated
07/15/2023
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