Healthcare Provider Details

I. General information

NPI: 1154619153
Provider Name (Legal Business Name): BARBARA IRASEMA LLANES DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 02/07/2022
Certification Date: 02/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 PONCE DE LEON BLVD STE 609
CORAL GABLES FL
33134-2074
US

IV. Provider business mailing address

7305 SW 142ND CT
MIAMI FL
33183-2961
US

V. Phone/Fax

Practice location:
  • Phone: 305-448-7217
  • Fax:
Mailing address:
  • Phone: 305-335-9615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN19454
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: