MEDICARE: DR. JULIO ANTONIO LLERA D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	8700	FL

General Provider Information

NPI Number	:	1619122876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIO ANTONIO LLERA D.D.S.

Provider Business Mailing Address
First Line	:	2607 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3029
Country	:	US
Telephone Number	:	954-587-7111
Fax Number	:	954-791-2314

Provider Business Practice Location Address
First Line	:	2607 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3029
Country	:	US
Telephone Number	:	954-587-7111
Fax Number	:	954-791-2314

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/01/2008
Last Update Date	:	12/01/2008

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