Provider Demographics
NPI:1437937034
Name:ILAS, PATRICIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:ILAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1349 COUNTRY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-3438
Mailing Address - Country:US
Mailing Address - Phone:408-571-9550
Mailing Address - Fax:
Practice Address - Street 1:1206 N CAPITOL AVE STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95132-2572
Practice Address - Country:US
Practice Address - Phone:408-928-1450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1094471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice