Healthcare Provider Details

I. General information

NPI: 1164874962
Provider Name (Legal Business Name): ELIZABETA COKOVSKA DMD; PROSTHODONTIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETA COCEVA

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 07/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 PINNACLES DR
PALM COAST FL
32164-2596
US

IV. Provider business mailing address

1391 CHAPARRAL LN
WINTER SPRINGS FL
32708-4853
US

V. Phone/Fax

Practice location:
  • Phone: 386-437-5253
  • Fax:
Mailing address:
  • Phone: 407-965-9967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number21687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: