Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | DN 15838 | FL |
NPI | 1033329735 |
---|---|
Provider Name | Dr. Juan Gabriel Llano |
First Address | Doral, FL 33166 |
Second Address | Doral, FL 33166 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |