Healthcare Provider Details

I. General information

NPI: 1669965679
Provider Name (Legal Business Name): ELIZABETH EVE DMD, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 LENOX AVE BLDG K
NEW YORK NY
10037-1802
US

IV. Provider business mailing address

380 RECTOR PL APT 3M
NEW YORK NY
10280-1443
US

V. Phone/Fax

Practice location:
  • Phone: 212-939-2890
  • Fax:
Mailing address:
  • Phone: 510-676-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number060327
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number65258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: