MEDICARE: IGOR BILOV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN22108	FL

General Provider Information

NPI Number	:	1710430079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGOR BILOV

Provider Business Mailing Address
First Line	:	1541 GERONA TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-4962
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1541 GERONA TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-4962
Country	:	US
Telephone Number	:	561-376-0777
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/03/2016
Last Update Date	:	08/03/2016

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Directions to “ IGOR BILOV ” Practice Location

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