Provider Demographics
NPI:1275088866
Name:HANKS, ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:HANKS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4530 EASTGATE BLVD STE 620
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45245-1256
Mailing Address - Country:US
Mailing Address - Phone:513-753-9111
Mailing Address - Fax:513-753-9111
Practice Address - Street 1:4530 EASTGATE BLVD STE 620
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1256
Practice Address - Country:US
Practice Address - Phone:513-753-9111
Practice Address - Fax:513-753-9111
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025626122300000X, 1223G0001X
KY9849122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist