Healthcare Provider Details

I. General information

NPI: 1134433873
Provider Name (Legal Business Name): ELIZABETH ESCARRIA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2010
Last Update Date: 10/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 DUNDEE AVE
ELGIN IL
60120
US

IV. Provider business mailing address

995 COLONY LANE
HOFFMAN ESTATE IL
60192
US

V. Phone/Fax

Practice location:
  • Phone: 847-488-9145
  • Fax: 847-488-9147
Mailing address:
  • Phone: 857-383-0822
  • Fax: 847-488-9147

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number1855530
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number19184
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019028852
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: