Healthcare Provider Details

I. General information

NPI: 1033329735
Provider Name (Legal Business Name): JUAN GABRIEL LLANO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3650 NW 82 AVENUE SUITE 303
DORAL FL
33166
US

IV. Provider business mailing address

3650 NW 82 AVENUE SUITE 303
DORAL FL
33166
US

V. Phone/Fax

Practice location:
  • Phone: 305-477-7668
  • Fax:
Mailing address:
  • Phone: 305-477-7668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDN 15838
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: