MEDICARE: ILLUSTRADENT EASTSIDE DENTAL SERVICES, PLLC

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	1223G0001X	General Practice Dentistry	052167	NY

General Provider Information

NPI Number	:	1942463609
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLUSTRADENT EASTSIDE DENTAL SERVICES, PLLC

Provider Business Mailing Address
First Line	:	810 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	212-480-2111
Fax Number	:

Provider Business Practice Location Address
First Line	:	810 2ND AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10017-4502
Country	:	US
Telephone Number	:	212-480-2111
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ALEXANDER JOSEPH PILAVSKY
Credential	:	DDS
Telephone Number	:	212-480-2111

Provider Enumeration Date	:	07/02/2008
Last Update Date	:	07/02/2008

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