Healthcare Provider Details

I. General information

NPI: 1750551545
Provider Name (Legal Business Name): VENETA KOTEVSKA DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2008
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 PAOLI PIKE STE 101
FLOYDS KNOBS IN
47119-9681
US

IV. Provider business mailing address

4801 PAOLI PIKE STE 101
FLOYDS KNOBS IN
47119-9681
US

V. Phone/Fax

Practice location:
  • Phone: 812-923-9004
  • Fax: 812-923-9088
Mailing address:
  • Phone: 812-923-9004
  • Fax: 812-923-9088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number12011378A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: