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General NPI Number Information
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NPI Number | 1508356197
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Entity Type | Individual
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Provider Name | EVELINA DAVYDOVA DMD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2018
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Last Update Date | 09/13/2023
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Provider Practice Location Address
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Address Line | 119 W 57TH ST STE 512
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City | NEW YORK
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State | NY
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Zip | 10019-2302
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Country | US
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Telephone | 347-702-3052
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Fax |
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Provider Business Mailing Address
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Address Line | 10849 63RD AVE APT 1P
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City | FOREST HILLS
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State | NY
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Zip | 11375-1360
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Country | US
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Telephone | 347-702-3052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12612
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060590-01
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License Number State | NY
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