Healthcare Provider Details

I. General information

NPI: 1992907471
Provider Name (Legal Business Name): ELIZABETH K. PRADA DA COSTA D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

223 N LIME ST
LANCASTER PA
17602-2748
US

IV. Provider business mailing address

223 N LIME ST
LANCASTER PA
17602-2748
US

V. Phone/Fax

Practice location:
  • Phone: 717-394-3793
  • Fax: 717-396-7409
Mailing address:
  • Phone: 717-394-3793
  • Fax: 717-396-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS036963
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number15333
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number2901020620
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: