Healthcare Provider Details

I. General information

NPI: 1871154153
Provider Name (Legal Business Name): LAURA LLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 06/15/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7735 NW 146TH ST STE 101
MIAMI LAKES FL
33016-1583
US

IV. Provider business mailing address

17920 NW 85TH AVE
HIALEAH FL
33015-2505
US

V. Phone/Fax

Practice location:
  • Phone: 55-560-5283
  • Fax:
Mailing address:
  • Phone: 786-447-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN24293
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: