Provider Demographics
NPI:1639360837
Name:TZUR, ILAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ILAN
Middle Name:
Last Name:TZUR
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 1:809 STATE ROUTE 208
Mailing Address - Street 2:STE 4
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-1829
Mailing Address - Country:US
Mailing Address - Phone:845-782-5040
Mailing Address - Fax:845-782-3478
Practice Address - Street 1:809 STATE ROUTE 208
Practice Address - Street 2:STE 4
Practice Address - City:MONROE
Practice Address - State:NY
Practice Address - Zip Code:10950-1829
Practice Address - Country:US
Practice Address - Phone:845-782-5040
Practice Address - Fax:845-782-3478
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0472251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01783820Medicaid