MEDICARE: ELIZAZETH PERKS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN15530	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336242296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZAZETH PERKS DMD

Provider Business Mailing Address
First Line	:	2849 CHANCERY LN STE 106
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33759-1427
Country	:	US
Telephone Number	:	813-422-2599
Fax Number	:	813-422-2599

Provider Business Practice Location Address
First Line	:	3115 W COLUMBUS DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-1865
Country	:	US
Telephone Number	:	813-422-2599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	10/26/2020

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Directions to “ ELIZAZETH PERKS DMD” Practice Location

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