Provider Demographics
NPI:1255466256
Name:LENSE, ELIZABETH C (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:LENSE
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 1:2570 RIVERSIDE PARKWAY
Mailing Address - Street 2:P.O. BOX 897
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-0897
Mailing Address - Country:US
Mailing Address - Phone:770-339-4260
Mailing Address - Fax:
Practice Address - Street 1:1329 PORTMAN DR SE
Practice Address - Street 2:STE D
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-6619
Practice Address - Country:US
Practice Address - Phone:770-786-5936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0109801223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health