Provider Demographics
NPI:1265644223
Name:ROSARIO-LLANTIN, JUDITH (DMD)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:ROSARIO-LLANTIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 KOUSA TRL
Mailing Address - Street 2:
Mailing Address - City:CHAPEL HILL
Mailing Address - State:NC
Mailing Address - Zip Code:27516-4669
Mailing Address - Country:US
Mailing Address - Phone:919-768-3998
Mailing Address - Fax:
Practice Address - Street 1:107 INDUSTRIAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2371
Practice Address - Country:US
Practice Address - Phone:919-496-8112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2012-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR27161223G0001X
NC1509091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice