Provider Demographics
NPI:1588844476
Name:KOVEOS, EFTHIMIOS EMMANUEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:EFTHIMIOS
Middle Name:EMMANUEL
Last Name:KOVEOS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 MOBERLY CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-0251
Mailing Address - Country:US
Mailing Address - Phone:781-206-6807
Mailing Address - Fax:
Practice Address - Street 1:4203 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-4925
Practice Address - Country:US
Practice Address - Phone:772-206-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC105191223G0001X
MADN185861223G0001X
FLDN162511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1588844476OtherGENERAL DENTIST