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General NPI Number Information
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NPI Number | 1053519041
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Entity Type | Individual
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Provider Name | ILONA FOTEK D.M.D,M.S.
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Gender | Female
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Dates
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Enumeration Date | 07/11/2007
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Last Update Date | 11/10/2010
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Provider Practice Location Address
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Address Line | 1401 FORUM WAY STE 800
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City | WEST PALM BEACH
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State | FL
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Zip | 33401-2322
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Country | US
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Telephone | 561-327-6664
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Fax |
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Provider Business Mailing Address
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Address Line | 111 LA VIDA CT
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33418-1720
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Country | US
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Telephone | 561-779-7058
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN17982
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License Number State | FL
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