Provider Demographics
NPI:1427678432
Name:KOKAREVA, ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:KOKAREVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12905 SW 223RD LN
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33170-6586
Mailing Address - Country:US
Mailing Address - Phone:786-554-1370
Mailing Address - Fax:
Practice Address - Street 1:131 MERRIMACK ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1723
Practice Address - Country:US
Practice Address - Phone:978-788-9338
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-20
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1859320122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist