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General NPI Number Information
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NPI Number | 1861503765
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Entity Type | Individual
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Provider Name | ELIZABETH A DEMICHELIS DDS
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Gender | Female
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1207 14TH STREET
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City | MODESTO
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State | CA
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Zip | 95354
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Country | US
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Telephone | 209-522-2348
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Fax | 209-552-2342
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Provider Business Mailing Address
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Address Line | 1207 14TH STREET
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City | MODESTO
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State | CA
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Zip | 95354
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Country | US
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Telephone | 209-522-2348
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Fax | 209-552-2342
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40427
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License Number State | CA
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