=====================================================
General NPI Number Information
=====================================================
NPI Number | 1750105953
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CARLITO P ILAWAN, DDS, COVINGTON, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2024
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 400 MYRTLE DR
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-8149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-892-2711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 400 MYRTLE DR
-----------------------------------------------------
City | COVINGTON
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70433-8149
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-892-2711
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST/OWNER
-----------------------------------------------------
Name | DR. CARLITO ILAWAN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 504-453-1409
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------