Elias Kouvalis, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D11378 Issued in MN

Practice address

13911 Ridgedale Dr
Suite 395
Minnetonka, MN 55305-1771

Phone

(952) 545-8603

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321315200000",
    "number": "1457412264",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13911 RIDGEDALE DRIVE, SUITE 395",
            "address_2": "PARK DENTAL RIDGEPARK",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "55305",
            "telephone_number": "952-545-8603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13911 RIDGEDALE DR",
            "address_2": "SUITE 395",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553051771",
            "telephone_number": "952-545-8603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOUVALIS",
        "first_name": "ELIAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2011-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D11378",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "603023800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Max Kostecki, O.D.
• Jasmine Marie Kotchian
• Elina Kotlyar, CCC-SLP
• Annabella Elizabeth Kottke
• Hengameh Kourehpazan
• Logan Kovacs, DPT
• Andrea Jeanne Kozak, FNP
• Jill Gurwitz Kozberg, M. A.
• Kathryn Kozloski
• Christina Kozlowski, APRN

• General Practice Dentistry in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.