Provider Demographics
NPI:1710112081
Name:YULIYA ELEVICH RDH, LLC
Entity Type:Organization
Organization Name:YULIYA ELEVICH RDH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - RDH
Authorized Official - Prefix:
Authorized Official - First Name:YULIYA
Authorized Official - Middle Name:V
Authorized Official - Last Name:ELEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-470-0339
Mailing Address - Street 1:12492 CLERMONT ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241-3045
Mailing Address - Country:US
Mailing Address - Phone:720-470-0339
Mailing Address - Fax:
Practice Address - Street 1:6240 S MAIN ST
Practice Address - Street 2:SUITE 260
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5376
Practice Address - Country:US
Practice Address - Phone:303-928-7575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO904626124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty