Provider Demographics
NPI:1295596112
Name:ELIZABETH MANCHESTER DDS PLLC
Entity type:Organization
Organization Name:ELIZABETH MANCHESTER DDS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LYNN NICHOLE
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-943-6378
Mailing Address - Street 1:5340 CORPORATE CENTER LOOP SE STE A
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-5590
Mailing Address - Country:US
Mailing Address - Phone:360-943-6378
Mailing Address - Fax:360-943-4866
Practice Address - Street 1:5340 CORPORATE CENTER LOOP SE STE A
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-5590
Practice Address - Country:US
Practice Address - Phone:360-943-6378
Practice Address - Fax:360-943-4866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-18
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty