Individual
DR. JOHN P. ILITCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
15311 W MCNICHOLS RD, DETROIT, MI 48235-3723
(313) 838-0490
(248) 539-3347
Mailing address
17770 STONEBROOK DR, NORTHVILLE, MI 48168-4329
(313) 838-0490
(248) 539-3347
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
14256
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14256
DENTAL LICENSE
MI
Enumeration date
02/06/2007
Last updated
07/08/2007
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