Healthcare Provider Details

I. General information

NPI: 1881792299
Provider Name (Legal Business Name): CARLOS LLANES DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4921 E BELL RD SUITE 206
SCOTTSDALE AZ
85254-6002
US

IV. Provider business mailing address

5025 N CENTRAL AVE # 403
PHOENIX AZ
85012-1520
US

V. Phone/Fax

Practice location:
  • Phone: 602-404-7700
  • Fax: 602-404-7712
Mailing address:
  • Phone: 562-212-0810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD5461
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: