MEDICARE: DR. ELIZABETH G. ACQUAYE D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	21763	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	B217631	OTHER	TX	CHIP ID NUMBER

General Provider Information

NPI Number	:	1962530824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH G. ACQUAYE D.D.S.

Provider Business Mailing Address
First Line	:	1415 W BUCKINGHAM RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-4202
Country	:	US
Telephone Number	:	972-496-4300
Fax Number	:	972-496-4388

Provider Business Practice Location Address
First Line	:	1415 W BUCKINGHAM RD
Second Line	:
City	:	GARLAND
State	:	TX
Zip	:	75042-4202
Country	:	US
Telephone Number	:	972-496-4300
Fax Number	:	972-496-4388

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. ELIZABETH G. ACQUAYE D.D.S.” Practice Location

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