Provider Demographics
NPI:1033329735
Name:LLANO, JUAN GABRIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:GABRIEL
Last Name:LLANO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3650 NW 82 AVENUE
Mailing Address - Street 2:SUITE 303
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166
Mailing Address - Country:US
Mailing Address - Phone:305-477-7668
Mailing Address - Fax:
Practice Address - Street 1:3650 NW 82 AVENUE
Practice Address - Street 2:SUITE 303
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166
Practice Address - Country:US
Practice Address - Phone:305-477-7668
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 158381223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics