Provider Demographics
NPI:1013271048
Name:MENENDEZ LLERA, VIVIAN MARIA (DMD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:MARIA
Last Name:MENENDEZ LLERA
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 1:10026 GRIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33328-3301
Mailing Address - Country:US
Mailing Address - Phone:954-233-0707
Mailing Address - Fax:954-252-4309
Practice Address - Street 1:10026 GRIFFIN RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33328
Practice Address - Country:US
Practice Address - Phone:954-233-0707
Practice Address - Fax:954-252-4309
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN197991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice