Provider Demographics
NPI:1639259815
Name:HAJISHENGALLIS, EVLAMBIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVLAMBIA
Middle Name:
Last Name:HAJISHENGALLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:EVLAMBIA
Other - Middle Name:
Other - Last Name:HAROKOPAKIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:501 S PRESTON ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40292-0001
Mailing Address - Country:US
Mailing Address - Phone:502-852-5128
Mailing Address - Fax:502-852-7163
Practice Address - Street 1:501 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40292-0001
Practice Address - Country:US
Practice Address - Phone:502-852-5128
Practice Address - Fax:502-852-7163
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY83111223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100019150Medicaid
KY9181422OtherDORAL DENTAL