Provider Demographics
NPI:1881602134
Name:ILAN, PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:
Last Name:ILAN
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 1:14930 88TH ST # LL
Mailing Address - Street 2:
Mailing Address - City:HOWARD BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11414-1463
Mailing Address - Country:US
Mailing Address - Phone:718-551-8144
Mailing Address - Fax:718-843-4716
Practice Address - Street 1:14930 88TH ST # LL
Practice Address - Street 2:
Practice Address - City:HOWARD BEACH
Practice Address - State:NY
Practice Address - Zip Code:11414-1463
Practice Address - Country:US
Practice Address - Phone:718-551-8144
Practice Address - Fax:718-843-4716
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050219122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02337593Medicaid