Provider Demographics
NPI:1366849705
Name:ELIZABETH STAVES, D.D.S.
Entity Type:Organization
Organization Name:ELIZABETH STAVES, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:STAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:727-526-5900
Mailing Address - Street 1:5310 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2916
Mailing Address - Country:US
Mailing Address - Phone:727-526-5900
Mailing Address - Fax:727-526-5944
Practice Address - Street 1:5310 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2916
Practice Address - Country:US
Practice Address - Phone:727-526-5900
Practice Address - Fax:727-526-5944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13943261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental