Provider Demographics
NPI:1063008324
Name:OWENS, ELIZABETH (RDH,BS,PHDHP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:RDH,BS,PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 W 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-3109
Mailing Address - Country:US
Mailing Address - Phone:814-397-0449
Mailing Address - Fax:
Practice Address - Street 1:4040 W 15TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-3109
Practice Address - Country:US
Practice Address - Phone:814-397-0449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH013080L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist