Healthcare Provider Details

I. General information

NPI: 1639259815
Provider Name (Legal Business Name): EVLAMBIA HAJISHENGALLIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: EVLAMBIA HAROKOPAKIS DDS

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 02/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S PRESTON ST
LOUISVILLE KY
40292-0001
US

IV. Provider business mailing address

501 S PRESTON ST
LOUISVILLE KY
40292-0001
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5128
  • Fax: 502-852-7163
Mailing address:
  • Phone: 502-852-5128
  • Fax: 502-852-7163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number8311
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: