Provider Demographics
NPI:1386960805
Name:DOW, ELIZABETH A VIVONA (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A VIVONA
Last Name:DOW
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4750 VILLAGE PLAZA LOOP STE 200
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6607
Mailing Address - Country:US
Mailing Address - Phone:541-683-8646
Mailing Address - Fax:541-686-3334
Practice Address - Street 1:4750 VILLAGE PLAZA LOOP STE 200
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6607
Practice Address - Country:US
Practice Address - Phone:541-683-8646
Practice Address - Fax:541-686-3334
Is Sole Proprietor?:No
Enumeration Date:2010-04-08
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD96491223G0001X
COD104071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice