Provider Demographics
NPI:1548432149
Name:ALIL DENTAL PC
Entity Type:Organization
Organization Name:ALIL DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ILINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-331-3563
Mailing Address - Street 1:1747 BAY RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11204-5016
Mailing Address - Country:US
Mailing Address - Phone:718-331-3563
Mailing Address - Fax:718-256-9110
Practice Address - Street 1:1747 BAY RIDGE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11204-5016
Practice Address - Country:US
Practice Address - Phone:718-331-3563
Practice Address - Fax:718-256-9110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0442201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01351115Medicaid