Provider Demographics
NPI:1396958963
Name:CLARY, ELIZABETH W (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:W
Last Name:CLARY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2 WAINWRIGHT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-4501
Mailing Address - Country:US
Mailing Address - Phone:636-239-8468
Mailing Address - Fax:636-239-8928
Practice Address - Street 1:2 WAINWRIGHT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-4501
Practice Address - Country:US
Practice Address - Phone:636-239-8468
Practice Address - Fax:636-239-8928
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005019249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist