Provider Demographics
NPI:1306275284
Name:DAVIS, ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:COLEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:14212 AMBAUM BLVD SW
Mailing Address - Street 2:SUITE100
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1449
Mailing Address - Country:US
Mailing Address - Phone:206-762-8433
Mailing Address - Fax:206-767-5581
Practice Address - Street 1:14212 AMBAUM BLVD. SW
Practice Address - Street 2:SUITE 100
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98116
Practice Address - Country:US
Practice Address - Phone:206-762-8433
Practice Address - Fax:206-767-5581
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60383802122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist