Provider Demographics
NPI:1801402326
Name:LLERENA, ERNESTO (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:
Last Name:LLERENA
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 1:28441 S TAMIAMI TRL STE 206
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-3214
Mailing Address - Country:US
Mailing Address - Phone:239-317-0014
Mailing Address - Fax:
Practice Address - Street 1:3330 CAPITAL OAKS DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4513
Practice Address - Country:US
Practice Address - Phone:850-386-4602
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-21
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist