Provider Demographics
NPI:1235260407
Name:STEIN, ILYA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:STEIN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 AVENIDA DEL RIO
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2444
Mailing Address - Country:US
Mailing Address - Phone:305-915-0567
Mailing Address - Fax:561-431-2873
Practice Address - Street 1:10800 AVENIDA DEL RIO
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2444
Practice Address - Country:US
Practice Address - Phone:305-915-0567
Practice Address - Fax:561-431-2873
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN14972122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070167000Medicaid