Provider Demographics
NPI:1114305018
Name:ILLUSTRADENT KEY BISCAYNE PLLC
Entity Type:Organization
Organization Name:ILLUSTRADENT KEY BISCAYNE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARA
Authorized Official - Middle Name:
Authorized Official - Last Name:PILAVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-361-5493
Mailing Address - Street 1:236 WOODLANDS RD
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:NY
Mailing Address - Zip Code:10528-1322
Mailing Address - Country:US
Mailing Address - Phone:305-361-5493
Mailing Address - Fax:
Practice Address - Street 1:240 CRANDON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:KEY BISCAYNE
Practice Address - State:FL
Practice Address - Zip Code:33149-1543
Practice Address - Country:US
Practice Address - Phone:305-361-5493
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN18909122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty