Provider Demographics
NPI:1861556755
Name:LAUREL MANOR CENTER FOR COMPREHENSIVE DENISTRY, P.A.
Entity type:Organization
Organization Name:LAUREL MANOR CENTER FOR COMPREHENSIVE DENISTRY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DON
Authorized Official - Middle Name:J
Authorized Official - Last Name:ILKKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-430-1710
Mailing Address - Street 1:1950 LAUREL MANOR DR
Mailing Address - Street 2:SUITE 180
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5603
Mailing Address - Country:US
Mailing Address - Phone:352-430-1710
Mailing Address - Fax:
Practice Address - Street 1:1950 LAUREL MANOR DR
Practice Address - Street 2:SUITE 180
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5603
Practice Address - Country:US
Practice Address - Phone:352-430-1710
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 92391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty