Provider Demographics
NPI:1013010651
Name:KOZLOVITSER, YELENA Y (DDS)
Entity Type:Individual
Prefix:DR
First Name:YELENA
Middle Name:Y
Last Name:KOZLOVITSER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1113 S MILWAUKEE AVE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-3758
Mailing Address - Country:US
Mailing Address - Phone:847-362-7710
Mailing Address - Fax:847-362-7780
Practice Address - Street 1:1113 S MILWAUKEE AVE
Practice Address - Street 2:SUITE #103
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-3758
Practice Address - Country:US
Practice Address - Phone:847-362-7710
Practice Address - Fax:847-362-7780
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01926280122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist