Provider Demographics
NPI:1164576591
Name:BABECK, ILYA MEYER (DMD)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:MEYER
Last Name:BABECK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:ILYA
Other - Middle Name:MEYER
Other - Last Name:BABABEKOV
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:6209 W COMMERCIAL BLVD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2335
Mailing Address - Country:US
Mailing Address - Phone:954-726-3200
Mailing Address - Fax:954-276-0372
Practice Address - Street 1:6209 W COMMERCIAL BLVD
Practice Address - Street 2:SUITE #6
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33319-2335
Practice Address - Country:US
Practice Address - Phone:954-726-3200
Practice Address - Fax:954-276-0372
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0431101223G0001X
FLDN173651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice