Provider Demographics
NPI:1306834676
Name:PRISHKULNIK, ELIZABETH T (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:T
Last Name:PRISHKULNIK
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 1:490B W ZIA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7008
Mailing Address - Country:US
Mailing Address - Phone:505-428-7878
Mailing Address - Fax:
Practice Address - Street 1:490B W ZIA RD
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7008
Practice Address - Country:US
Practice Address - Phone:505-428-7878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-11
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048051223P0221X
NMDD27071223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry