Healthcare Provider Details

I. General information

NPI: 1659595106
Provider Name (Legal Business Name): LUIS M LLAMAS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5965 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

IV. Provider business mailing address

5965 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 305-662-7702
  • Fax: 305-662-2552
Mailing address:
  • Phone: 305-662-7702
  • Fax: 305-662-2552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8363
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: