Provider Demographics
NPI:1861656209
Name:EVYENIA KOLLIA DMD PLLC
Entity Type:Organization
Organization Name:EVYENIA KOLLIA DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVYENIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLIA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:206-743-5750
Mailing Address - Street 1:2701 EASTLAKE AVE E # 104
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3104
Mailing Address - Country:US
Mailing Address - Phone:206-588-0714
Mailing Address - Fax:206-588-0716
Practice Address - Street 1:2701 EASTLAKE AVE E # 104
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3104
Practice Address - Country:US
Practice Address - Phone:206-588-0714
Practice Address - Fax:206-588-0716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-15
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010405122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty