Healthcare Provider Details

I. General information

NPI: 1518919398
Provider Name (Legal Business Name): ELOVIC DENTAL ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

665 BEACON ST SUITE 300
BOSTON MA
02215-3202
US

IV. Provider business mailing address

665 BEACON ST SUITE 300
BOSTON MA
02215-3202
US

V. Phone/Fax

Practice location:
  • Phone: 617-247-8888
  • Fax: 617-247-8888
Mailing address:
  • Phone: 617-247-8888
  • Fax: 617-247-8888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number17592
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number17210
License Number StateMA

VIII. Authorized Official

Name: REBECCA ELOVIC
Title or Position: TREASURER
Credential: DMD
Phone: 617-247-8888