=====================================================
General NPI Number Information
=====================================================
NPI Number | 1710112081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | YULIYA ELEVICH RDH, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/15/2009
-----------------------------------------------------
Last Update Date | 05/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6240 S MAIN ST SUITE 260
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80016-5376
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-928-7575
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12492 CLERMONT ST
-----------------------------------------------------
City | THORNTON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80241-3045
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-470-0339
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER - RDH
-----------------------------------------------------
Name | YULIYA V ELEVICH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-470-0339
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 124Q00000X
-----------------------------------------------------
Taxonomy Name | Dental Hygienist
-----------------------------------------------------
License Number | 904626
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------