Provider Demographics
NPI:1063648970
Name:BIRR, ELIZABETH RAE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:RAE
Last Name:BIRR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:RAE
Other - Last Name:NGUYEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1819 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PLOVER
Mailing Address - State:WI
Mailing Address - Zip Code:54467-4304
Mailing Address - Country:US
Mailing Address - Phone:715-544-6100
Mailing Address - Fax:715-544-6104
Practice Address - Street 1:1819 PARK AVE
Practice Address - Street 2:
Practice Address - City:PLOVER
Practice Address - State:WI
Practice Address - Zip Code:54467-4304
Practice Address - Country:US
Practice Address - Phone:715-544-6100
Practice Address - Fax:715-544-6104
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6400-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice