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Larisa Ilyutovich
General Practice Dentistry in Fort Lee, New Jersey
NPI 1780033225

Larisa Ilyutovich is a General Practice Dentistry based in Fort Lee, NJ and is specialized in General Practice. Larisa Ilyutovich practices in Fort Lee, NJ. The NPI Number for Larisa Ilyutovich is 1780033225 and holds a License No. DI020299 (New Jersey).

The current practice location address for Larisa Ilyutovich is 301 Bridge Plz N, Fort Lee, NJ and can be reached out via phone at 201-346-4660 and via fax at 201-346-1116.

Location: 301 Bridge Plz N, Fort Lee, NJ, 07024-5059
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1780033225
Provider Name
Larisa Ilyutovich
Credential
Provider Entity Type
Individual
Gender
Male
Address
301 Bridge Plz N, Fort Lee, NJ, 07024-5059
Phone Number
201-346-4660
Fax Number
201-346-1116
Provider Enumeration Date
06/06/2016
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
8797404 05 NJ
institution
Provider Business Practice Location Address Details
Address
301 Bridge Plz N
City
Fort Lee
State
New Jersey
Zip
07024-5059
Phone Number
201-346-4660
Fax Number
201-346-1116
person
Provider Business Mailing Address Details
Address
301 Bridge Plz N
City
Fort Lee
State
New Jersey
Zip
07024-5059
Phone Number
201-346-4660
Fax Number
201-346-1116
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
DI020299 (New Jersey)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
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