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General NPI Number Information
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NPI Number | 1902052673
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Entity Type | Organization
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Legal Business Name | ILLUSTRADENT MIDTOWN DENTAL SERVICES, PLLC
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 358 5TH AVE SUITE 407
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City | NEW YORK
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State | NY
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Zip | 10001-2209
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Country | US
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Telephone | 212-244-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 358 5TH AVE SUITE 407
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City | NEW YORK
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State | NY
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Zip | 10001-2209
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Country | US
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Telephone | 212-244-4700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEXANDER JOSEPH PILAVSKY
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Credential | DDS
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Telephone | 212-244-4700
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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 | 50-052167
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License Number State | NY
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