Provider Demographics
NPI:1619122876
Name:LLERA, JULIO ANTONIO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIO
Middle Name:ANTONIO
Last Name:LLERA
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 1:2607 DAVIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-3029
Mailing Address - Country:US
Mailing Address - Phone:954-587-7111
Mailing Address - Fax:954-791-2314
Practice Address - Street 1:2607 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-3029
Practice Address - Country:US
Practice Address - Phone:954-587-7111
Practice Address - Fax:954-791-2314
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-01
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL87001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice