| Larisa Ilyutovich Dds Pc | |
|
301 Bridge Plaza North 2nd Flr Fort Lee NJ 07024 | |
| (201) 346-4660 | |
| (201) 346-1116 |
| Full Name | Larisa Ilyutovich Dds Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 301 Bridge Plaza North, Fort Lee, New Jersey |
| Authorized Official Name and Position | Larisa Ilyutovich (PRESIDENT OWNER) |
| Authorized Official Contact | 2013464660 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Larisa Ilyutovich Dds Pc 301 Bridge Plaza North 2nd Flr Fort Lee NJ 07024 Ph: (201) 346-4660 | Larisa Ilyutovich Dds Pc 301 Bridge Plaza North 2nd Flr Fort Lee NJ 07024 Ph: (201) 346-4660 |
| NPI Number | 1609954064 |
|---|---|
| Provider Enumeration Date | 11/02/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609954064 | NPI | - | NPPES |
| 8797404 | Medicaid | NJ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | DI020299 (New Jersey) | Primary |
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