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General NPI Number Information
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NPI Number | 1689798431
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Entity Type | Individual
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Provider Name | ELEVTERIA COUTRAS DMD
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Gender | Female
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2655 EAST OAKLAND PARK BLVD SUITE 5
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City | FT. LAUDERDALE
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State | FL
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Zip | 33306
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Country | US
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Telephone | 954-566-7569
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Fax | 954-566-7036
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Provider Business Mailing Address
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Address Line | 17050 NORTH BAY ROAD #1102
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City | SUNNY ISLES BEACH
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State | FL
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Zip | 33160
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Country | US
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Telephone | 954-566-7569
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Fax | 954-566-7036
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN16690
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License Number State | FL
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