Provider Demographics
NPI:1568684280
Name:AMES, ILYA (DDS)
Entity Type:Individual
Prefix:
First Name:ILYA
Middle Name:
Last Name:AMES
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 1:1200 WATERS PL
Mailing Address - Street 2:SUITE M107
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-2728
Mailing Address - Country:US
Mailing Address - Phone:718-822-8787
Mailing Address - Fax:718-823-6996
Practice Address - Street 1:1200 WATERS PL
Practice Address - Street 2:SUITE M107
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-2728
Practice Address - Country:US
Practice Address - Phone:718-822-8787
Practice Address - Fax:718-823-6996
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0516751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice