Provider Demographics
NPI:1629189907
Name:YANKELEVICH, EKATERINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EKATERINA
Middle Name:
Last Name:YANKELEVICH
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 1:4146 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-4573
Mailing Address - Country:US
Mailing Address - Phone:614-459-3689
Mailing Address - Fax:
Practice Address - Street 1:1151 S HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43206-3434
Practice Address - Country:US
Practice Address - Phone:614-443-3400
Practice Address - Fax:614-443-4092
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-212981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2255581Medicaid