Provider Demographics
NPI:1043435852
Name:WILLIS, ELIZABETH K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:K
Last Name:WILLIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:K
Other - Last Name:UECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2206 W PARMER LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-4330
Mailing Address - Country:US
Mailing Address - Phone:512-835-1924
Mailing Address - Fax:512-835-2585
Practice Address - Street 1:2206 W PARMER LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727-4330
Practice Address - Country:US
Practice Address - Phone:512-835-1924
Practice Address - Fax:512-835-2585
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX182011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice