Healthcare Provider Details

I. General information

NPI: 1780172379
Provider Name (Legal Business Name): YELIZAVETA LUCHKOVSKA HERON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YELIZAVETA LUCHKOVSKA DDS

II. Dates (important events)

Enumeration Date: 04/29/2018
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 MISSION RD
SOUTH SAN FRANCISCO CA
94080-1397
US

IV. Provider business mailing address

1215 MISSION RD
SOUTH SAN FRANCISCO CA
94080-1397
US

V. Phone/Fax

Practice location:
  • Phone: 650-871-5437
  • Fax:
Mailing address:
  • Phone: 831-325-1815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number104020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: