Provider Demographics
NPI:1982339867
Name:BEDOYA LEAL, MARTHA LILIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:LILIANA
Last Name:BEDOYA LEAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9242 SHADOW OAK LN
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34120-5270
Mailing Address - Country:US
Mailing Address - Phone:239-777-2804
Mailing Address - Fax:
Practice Address - Street 1:5064 ANNUNCIATION CIR
Practice Address - Street 2:
Practice Address - City:AVE MARIA
Practice Address - State:FL
Practice Address - Zip Code:34142-9671
Practice Address - Country:US
Practice Address - Phone:239-919-6930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-23
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN29499122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program