Provider Demographics
NPI:1689798431
Name:COUTRAS, ELEVTERIA (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELEVTERIA
Middle Name:
Last Name:COUTRAS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17050 NORTH BAY ROAD
Mailing Address - Street 2:#1102
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160
Mailing Address - Country:US
Mailing Address - Phone:954-566-7569
Mailing Address - Fax:954-566-7036
Practice Address - Street 1:2655 EAST OAKLAND PARK BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:FT. LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306
Practice Address - Country:US
Practice Address - Phone:954-566-7569
Practice Address - Fax:954-566-7036
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN166901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice