Provider Demographics
NPI:1639334121
Name:EVTIMOVSKA, ELIZABETA (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETA
Middle Name:
Last Name:EVTIMOVSKA
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 1:9500 EUCLID AVE A71
Mailing Address - Street 2:HEAD AND NECK INSTITUTE/DENTAL SERVICE
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-8202
Mailing Address - Country:US
Mailing Address - Phone:216-444-4802
Mailing Address - Fax:216-444-8570
Practice Address - Street 1:9500 EUCLID AVE # A71
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195
Practice Address - Country:US
Practice Address - Phone:216-444-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-23
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.0256671223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA102310598Medicaid