Healthcare Provider Details

I. General information

NPI: 1225606577
Provider Name (Legal Business Name): ELIZABETH ANNE ABRUZZO DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2021
Last Update Date: 06/14/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COMMANDING OFFICER, 2D DENBN/NDC, PSC 20130 315 MCHUGH BLVD
CAMP LEJEUNE NC
28542
US

IV. Provider business mailing address

COMMANDING OFFICER, 2D DENBN/NDC, PSC 20130 315 MCHUGH BLVD
CAMP LEJEUNE NC
28542
US

V. Phone/Fax

Practice location:
  • Phone: 910-451-2208
  • Fax:
Mailing address:
  • Phone: 910-451-2208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11724
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number11724
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: