Healthcare Provider Details

I. General information

NPI: 1508551102
Provider Name (Legal Business Name): ELIZABETH ANN DENNIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 SAULSBURY RD
DOVER DE
19904-3444
US

IV. Provider business mailing address

501 W 14TH ST
WILMINGTON DE
19801-1013
US

V. Phone/Fax

Practice location:
  • Phone: 302-678-2942
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberG1-0011587
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: