MEDICARE: JULIO A. LLERA, D.D.S.,P.A.

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	122300000X	Dentist

General Provider Information

NPI Number	:	1700061140
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIO A. LLERA, D.D.S.,P.A.

Provider Business Mailing Address
First Line	:	2607 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3029
Country	:	US
Telephone Number	:	954-587-7111
Fax Number	:	954-587-7114

Provider Business Practice Location Address
First Line	:	2607 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-3029
Country	:	US
Telephone Number	:	954-587-7111
Fax Number	:	954-587-7114

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JULIO LLERA
Credential	:	DDS
Telephone Number	:	954-587-7111

Provider Enumeration Date	:	01/03/2008
Last Update Date	:	06/26/2008

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