Provider Demographics
NPI:1275169849
Name:WEST, ILSA LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ILSA
Middle Name:LYNN
Last Name:WEST
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 DEERFIELD RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6009
Mailing Address - Country:US
Mailing Address - Phone:404-788-1821
Mailing Address - Fax:
Practice Address - Street 1:2 HAMILL RD STE 266
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-1894
Practice Address - Country:US
Practice Address - Phone:410-435-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041943122300000X, 1223P0221X
MD169301223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist