Healthcare Provider Details

I. General information

NPI: 1598329492
Provider Name (Legal Business Name): ILANA ZINN DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 PENN AVE. FACULTY PAVILION #7108
PITTSBURGH PA
15224-1522
US

IV. Provider business mailing address

4401 PENN AVE. FACULTY PAVILION #7108
PITTSBURGH PA
15224-1852
US

V. Phone/Fax

Practice location:
  • Phone: 732-757-8148
  • Fax:
Mailing address:
  • Phone: 732-757-8148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number16769
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: