Provider Demographics
NPI:1811037070
Name:LELCHUK, IRA SHELDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:SHELDON
Last Name:LELCHUK
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 1:4300 ALTON RD # 1190
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2800
Mailing Address - Country:US
Mailing Address - Phone:305-532-1444
Mailing Address - Fax:305-532-0404
Practice Address - Street 1:4300 ALTON RD # 1190
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2800
Practice Address - Country:US
Practice Address - Phone:305-532-1444
Practice Address - Fax:305-532-0404
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN89191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice