Provider Demographics
NPI:1902537061
Name:YERO, LISANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LISANDRA
Middle Name:
Last Name:YERO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-6734
Mailing Address - Country:US
Mailing Address - Phone:407-205-3368
Mailing Address - Fax:
Practice Address - Street 1:1913 N CLYDE MORRIS BLVD STE 130
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5519
Practice Address - Country:US
Practice Address - Phone:386-274-2021
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL269221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice