Provider Demographics
NPI:1942306394
Name:LLEO, PEDRO DANIEL (DDS)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:DANIEL
Last Name:LLEO
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 1:18400 NW 75TH PL STE 121
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2958
Mailing Address - Country:US
Mailing Address - Phone:305-381-5412
Mailing Address - Fax:786-360-2404
Practice Address - Street 1:18400 NW 75TH PL STE 121
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-2958
Practice Address - Country:US
Practice Address - Phone:305-381-5412
Practice Address - Fax:786-360-2404
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN173101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice