Provider Demographics
NPI:1275093973
Name:FLOODEEN, ELIZABETH GRACE KNOFF (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GRACE KNOFF
Last Name:FLOODEEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AUGUSTA UNIVERSITY DENTAL COLLEGE OF GEORGIA
Mailing Address - Street 2:1120 15TH ST
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912
Mailing Address - Country:US
Mailing Address - Phone:706-721-9744
Mailing Address - Fax:
Practice Address - Street 1:AUGUSTA UNIVERSITY DENTAL COLLEGE OF GEORGIA
Practice Address - Street 2:1120 15TH ST
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-1270
Practice Address - Country:US
Practice Address - Phone:706-721-9744
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WA61058433204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program