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General NPI Number Information
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NPI Number | 1821472325
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Entity Type | Individual
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Provider Name | ELIZABETH STANDISH D.D.S., M.S.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2015
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Last Update Date | 12/16/2024
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Provider Practice Location Address
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Address Line | 3743 LANDMARK DR STE 300
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City | LAFAYETTE
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State | IN
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Zip | 47905-6656
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Country | US
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Telephone | 765-340-7790
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Fax | 765-680-0303
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Provider Business Mailing Address
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Address Line | 1125 KINGSWOOD RD S
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City | WEST LAFAYETTE
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State | IN
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Zip | 47906-4671
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Country | US
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Telephone | 409-370-0570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 12012992A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 12012992A
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License Number State | IN
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