Provider Demographics
NPI:1417279134
Name:EVANS, ANA ELASHVILI (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:ELASHVILI
Last Name:EVANS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 S GILPIN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80209-4512
Mailing Address - Country:US
Mailing Address - Phone:720-255-7047
Mailing Address - Fax:303-724-7079
Practice Address - Street 1:13065 E 17TH AVE
Practice Address - Street 2:MAIL STOP F 742
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2532
Practice Address - Country:US
Practice Address - Phone:303-724-5505
Practice Address - Fax:303-724-5456
Is Sole Proprietor?:No
Enumeration Date:2010-02-22
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO501122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist