Provider Demographics
NPI:1972632123
Name:ROWOLD-GARCIAMENDEZ, ELISABETH IRENE (DDS, MS)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:IRENE
Last Name:ROWOLD-GARCIAMENDEZ
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 N ALLEN DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-2539
Mailing Address - Country:US
Mailing Address - Phone:972-727-0011
Mailing Address - Fax:972-727-0707
Practice Address - Street 1:335 N ALLEN DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-2539
Practice Address - Country:US
Practice Address - Phone:972-727-0011
Practice Address - Fax:972-727-0707
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX184251223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0000ZBX696OtherBCBS OF MA ID#
AL900-53478OtherBCBS OF ALABAMA ID#
UT75288660401011OtherBCBS OF UTAH ID#
TX861423OtherUNITED CONCORDIA ID #
TX85D713OtherBCBS OF TEXAS PROVIDER #