Provider Demographics
NPI:1902832793
Name:EGLITIS, ILZE IRENE (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:ILZE
Middle Name:IRENE
Last Name:EGLITIS
Suffix:
Gender:F
Credentials:DDS MS
Other - Prefix:MS
Other - First Name:ILZE
Other - Middle Name:IRENE
Other - Last Name:EGLITIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 MERWIN RD
Mailing Address - Street 2:
Mailing Address - City:VALATIE
Mailing Address - State:NY
Mailing Address - Zip Code:12184-4438
Mailing Address - Country:US
Mailing Address - Phone:518-392-5566
Mailing Address - Fax:
Practice Address - Street 1:STRATTON VA MEDICAL CENTER
Practice Address - Street 2:113 HOLLAND AVENUE
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12208
Practice Address - Country:US
Practice Address - Phone:518-626-6570
Practice Address - Fax:518-626-6584
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036226-11223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics