MEDICARE: DR. CHARLES D. LLANO D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 6425	FL

General Provider Information

NPI Number	:	1093820995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES D. LLANO D.D.S.

Provider Business Mailing Address
First Line	:	320 W HIGHLAND DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1543
Country	:	US
Telephone Number	:	863-644-2428
Fax Number	:	863-644-6235

Provider Business Practice Location Address
First Line	:	320 W HIGHLAND DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33813-1543
Country	:	US
Telephone Number	:	863-644-2428
Fax Number	:	863-644-6235

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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