Provider Demographics
NPI:1407816663
Name:LLANEZA, LUIS R (DDS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:R
Last Name:LLANEZA
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:PO BOX 71403
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00936-8503
Mailing Address - Country:US
Mailing Address - Phone:787-292-2083
Mailing Address - Fax:787-889-5507
Practice Address - Street 1:28 CALLE FERNANDEZ GARCIA
Practice Address - Street 2:SUITE #16
Practice Address - City:LUQUILLO
Practice Address - State:PR
Practice Address - Zip Code:00773-2261
Practice Address - Country:US
Practice Address - Phone:787-889-5507
Practice Address - Fax:787-889-5507
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR22551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice