Organization
LARISA ILYUTOVICH DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LARISA ILYUTOVICH DDS (PRESIDENT OWNER)
(201) 346-4660
Entity
Organization
Contact information
Practice address
301 BRIDGE PLAZA NORTH, 2ND FLR, FORT LEE, NJ 07024
(201) 346-4660
(201) 346-1116
Mailing address
301 BRIDGE PLAZA NORTH, 2ND FLR, FORT LEE, NJ 07024
(201) 346-4660
(201) 346-1116
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DI020299
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8797404
—
NJ
Enumeration date
11/02/2006
Last updated
08/22/2020
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