Healthcare Provider Details

I. General information

NPI: 1902725930
Provider Name (Legal Business Name): LAUDERDALE DENTAL AND IMPLANT CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 SE 12TH ST
FORT LAUDERDALE FL
33316-1901
US

IV. Provider business mailing address

415 SE 12TH ST
FORT LAUDERDALE FL
33316-1901
US

V. Phone/Fax

Practice location:
  • Phone: 754-224-1555
  • Fax:
Mailing address:
  • Phone: 754-224-1555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ILYA LAPIN
Title or Position: OWNER
Credential: DDS
Phone: 347-415-4452