Provider Demographics
NPI:1316462757
Name:KILPATRICK, ELIZABETH JANE (DMD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:KILPATRICK
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 1:611 BETHLEHEM RD
Mailing Address - Street 2:
Mailing Address - City:CATASAUQUA
Mailing Address - State:PA
Mailing Address - Zip Code:18032-1315
Mailing Address - Country:US
Mailing Address - Phone:610-737-7865
Mailing Address - Fax:
Practice Address - Street 1:2796 PA-611
Practice Address - Street 2:
Practice Address - City:TANNERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18372
Practice Address - Country:US
Practice Address - Phone:570-629-1570
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-07
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS041492122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist