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General NPI Number Information
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NPI Number | 1679772461
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Entity Type | Organization
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Legal Business Name | DON J. ILKKA DDS, PA
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Dates
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Enumeration Date | 07/12/2007
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Last Update Date | 07/12/2007
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Provider Practice Location Address
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Address Line | 8301 COUNTY ROAD 44 LEG A
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City | LEESBURG
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State | FL
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Zip | 34788-3706
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Country | US
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Telephone | 352-787-4748
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Fax | 352-787-7299
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Provider Business Mailing Address
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Address Line | 8301 COUNTY ROAD 44 LEG A
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City | LEESBURG
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State | FL
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Zip | 34788-3706
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Country | US
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Telephone | 352-787-4748
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Fax | 352-787-7299
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DON JOHN ILKKA
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Credential | DDS
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Telephone | 352-787-4748
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN9239
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License Number State | FL
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