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General NPI Number Information
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NPI Number | 1285966671
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Entity Type | Organization
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Legal Business Name | BRAINARD G. LLANES DDS, LTD.
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Dates
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Enumeration Date | 02/10/2010
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Last Update Date | 02/10/2010
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Provider Practice Location Address
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Address Line | 818 E NERGE RD
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City | ROSELLE
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State | IL
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Zip | 60172-4884
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Country | US
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Telephone | 630-582-0878
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Fax | 630-582-0898
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Provider Business Mailing Address
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Address Line | 818 E NERGE RD
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City | ROSELLE
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State | IL
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Zip | 60172-4884
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Country | US
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Telephone | 630-582-0878
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Fax | 630-582-0898
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAINARD G. LLANES
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Credential | DDS
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Telephone | 312-953-2953
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019.025966
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License Number State | IL
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