Provider Demographics
NPI:1851530497
Name:TRIANA, ILEANA AMBROSINA (DD,S)
Entity type:Individual
Prefix:MS
First Name:ILEANA
Middle Name:AMBROSINA
Last Name:TRIANA
Suffix:
Gender:F
Credentials:DD,S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9790 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2902
Mailing Address - Country:US
Mailing Address - Phone:305-554-9797
Mailing Address - Fax:305-554-9788
Practice Address - Street 1:9790 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2902
Practice Address - Country:US
Practice Address - Phone:305-554-9797
Practice Address - Fax:305-554-9788
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN146751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice