Provider Demographics
NPI:1154642775
Name:AULD, ELIZABETH L (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:L
Last Name:AULD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12117 COURSEY BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-4410
Mailing Address - Country:US
Mailing Address - Phone:222-292-0016
Mailing Address - Fax:225-292-7200
Practice Address - Street 1:12117 COURSEY BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-4410
Practice Address - Country:US
Practice Address - Phone:222-292-0016
Practice Address - Fax:225-292-7200
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6040122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist