Provider Demographics
NPI:1093820995
Name:LLANO, CHARLES D (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:D
Last Name:LLANO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 W HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1543
Mailing Address - Country:US
Mailing Address - Phone:863-644-2428
Mailing Address - Fax:863-644-6235
Practice Address - Street 1:320 W HIGHLAND DR
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1543
Practice Address - Country:US
Practice Address - Phone:863-644-2428
Practice Address - Fax:863-644-6235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 64251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice