Provider Demographics
NPI:1629616479
Name:COLIN S. ILAS D.D.S.
Entity Type:Organization
Organization Name:COLIN S. ILAS D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINNETTE
Authorized Official - Middle Name:FELIPE
Authorized Official - Last Name:MANGOBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-928-1450
Mailing Address - Street 1:1206 N CAPITOL AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95132-2572
Mailing Address - Country:US
Mailing Address - Phone:408-928-1450
Mailing Address - Fax:408-928-1454
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:408-928-1454
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-11
Last Update Date:2019-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty