Provider Demographics
NPI:1881792299
Name:LLANES, CARLOS (DMD)
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:
Last Name:LLANES
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 1:5025 N CENTRAL AVE
Mailing Address - Street 2:# 403
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-1520
Mailing Address - Country:US
Mailing Address - Phone:562-212-0810
Mailing Address - Fax:
Practice Address - Street 1:4921 E BELL RD
Practice Address - Street 2:SUITE 206
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-6002
Practice Address - Country:US
Practice Address - Phone:602-404-7700
Practice Address - Fax:602-404-7712
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD5461122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist