Healthcare Provider Details

I. General information

NPI: 1538899976
Provider Name (Legal Business Name): ALEJANDRA LLANO DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 06/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13623 S DIXIE HWY STE 147
PALMETTO BAY FL
33176-7295
US

IV. Provider business mailing address

4701 NW 111TH CT
DORAL FL
33178-4366
US

V. Phone/Fax

Practice location:
  • Phone: 305-330-9882
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number27051
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: