Provider Demographics
NPI:1285966671
Name:BRAINARD G. LLANES DDS, LTD.
Entity type:Organization
Organization Name:BRAINARD G. LLANES DDS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAINARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:LLANES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-953-2953
Mailing Address - Street 1:818 E NERGE RD
Mailing Address - Street 2:
Mailing Address - City:ROSELLE
Mailing Address - State:IL
Mailing Address - Zip Code:60172-4884
Mailing Address - Country:US
Mailing Address - Phone:630-582-0878
Mailing Address - Fax:630-582-0898
Practice Address - Street 1:818 E NERGE RD
Practice Address - Street 2:
Practice Address - City:ROSELLE
Practice Address - State:IL
Practice Address - Zip Code:60172-4884
Practice Address - Country:US
Practice Address - Phone:630-582-0878
Practice Address - Fax:630-582-0898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0259661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty