Healthcare Provider Details

I. General information

NPI: 1285016774
Provider Name (Legal Business Name): ELIZABETH MARY POWERS DDS, MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2015
Last Update Date: 01/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 W 6TH ST STE 101
LAWRENCE KS
66049-3613
US

IV. Provider business mailing address

4320 W 6TH ST SUITE 101
LAWRENCE KS
66049
US

V. Phone/Fax

Practice location:
  • Phone: 785-856-5600
  • Fax:
Mailing address:
  • Phone: 402-910-6964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number61354
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberLDR150127
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: