Provider Demographics
NPI:1306947254
Name:UNGSON, ELIZABETH U (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:U
Last Name:UNGSON
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 1:1124 MISSION RD.
Mailing Address - Street 2:
Mailing Address - City:SSF
Mailing Address - State:CA
Mailing Address - Zip Code:94080
Mailing Address - Country:US
Mailing Address - Phone:650-872-3030
Mailing Address - Fax:650-872-3031
Practice Address - Street 1:1124 MISSION RD.
Practice Address - Street 2:
Practice Address - City:SSF
Practice Address - State:CA
Practice Address - Zip Code:94080
Practice Address - Country:US
Practice Address - Phone:650-872-3030
Practice Address - Fax:650-872-3031
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43404122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist