Provider Demographics
NPI:1083348502
Name:ILB DENTAL PLLC
Entity Type:Organization
Organization Name:ILB DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IRENI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAROUNIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-389-4400
Mailing Address - Street 1:38 MECHANIC ST STE 107
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-2072
Mailing Address - Country:US
Mailing Address - Phone:508-389-4400
Mailing Address - Fax:781-480-7677
Practice Address - Street 1:38 MECHANIC ST STE 107
Practice Address - Street 2:
Practice Address - City:FOXBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:02035-2072
Practice Address - Country:US
Practice Address - Phone:508-389-4400
Practice Address - Fax:781-480-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty