Provider Demographics
NPI:1346738317
Name:FRUSHON, ELIZABETH M (RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:M
Last Name:FRUSHON
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:M
Other - Last Name:PUZAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:959 WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18509-3023
Mailing Address - Country:US
Mailing Address - Phone:570-344-3517
Mailing Address - Fax:570-504-0427
Practice Address - Street 1:959 WYOMING AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18509-3023
Practice Address - Country:US
Practice Address - Phone:570-344-3517
Practice Address - Fax:570-504-0427
Is Sole Proprietor?:No
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000297124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist