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General NPI Number Information
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NPI Number | 1437508082
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Entity Type | Individual
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Provider Name | ILYA LAPIN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2016
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 1620 SE 4TH AVE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-2528
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Country | US
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Telephone | 866-393-5525
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Fax |
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Provider Business Mailing Address
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Address Line | 526 NE 8TH ST APT 21415
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City | FORT LAUDERDALE
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State | FL
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Zip | 33304-3168
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Country | US
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Telephone | 347-415-4452
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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 | DN22275
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License Number State | FL
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