Provider Demographics
NPI:1437508082
Name:LAPIN, ILYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ILYA
Middle Name:
Last Name:LAPIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:526 NE 8TH ST APT 21415
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3168
Mailing Address - Country:US
Mailing Address - Phone:347-415-4452
Mailing Address - Fax:
Practice Address - Street 1:1620 SE 4TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2528
Practice Address - Country:US
Practice Address - Phone:866-393-5525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-05
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN222751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice