Provider Demographics
NPI:1962530824
Name:ACQUAYE, ELIZABETH G (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:ACQUAYE
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 1:1415 W BUCKINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-4202
Mailing Address - Country:US
Mailing Address - Phone:972-496-4300
Mailing Address - Fax:972-496-4388
Practice Address - Street 1:1415 W BUCKINGHAM RD
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-4202
Practice Address - Country:US
Practice Address - Phone:972-496-4300
Practice Address - Fax:972-496-4388
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21763122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164599605Medicaid
TXB217631OtherCHIP ID NUMBER
TXB217631OtherCHIP ID NUMBER