Healthcare Provider Details

I. General information

NPI: 1649632217
Provider Name (Legal Business Name): ELIZABETH MAURER HEATH D.D.S., M.S.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 02/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12419 CANTRELL RD
LITTLE ROCK AR
72223
US

IV. Provider business mailing address

12419 CANTRELL RD
LITTLE ROCK AR
72223-1727
US

V. Phone/Fax

Practice location:
  • Phone: 501-223-8442
  • Fax: 501-224-2900
Mailing address:
  • Phone: 501-223-8442
  • Fax: 501-224-2900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number31710
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4253
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: