=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417279134
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANA ELASHVILI EVANS D.D.S., M.S.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2010
-----------------------------------------------------
Last Update Date | 12/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13065 E 17TH AVE MAIL STOP F 742
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80045-2532
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-724-5505
-----------------------------------------------------
Fax | 303-724-5456
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 624 S GILPIN ST
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80209-4512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-255-7047
-----------------------------------------------------
Fax | 303-724-7079
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 501
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------