Provider Demographics
NPI:1518919398
Name:ELOVIC DENTAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ELOVIC DENTAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:ELOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-247-8888
Mailing Address - Street 1:665 BEACON ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-3202
Mailing Address - Country:US
Mailing Address - Phone:617-247-8888
Mailing Address - Fax:617-247-8888
Practice Address - Street 1:665 BEACON ST
Practice Address - Street 2:SUITE 300
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-3202
Practice Address - Country:US
Practice Address - Phone:617-247-8888
Practice Address - Fax:617-247-8888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA172101223G0001X
MA175921223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty