Provider Demographics
NPI:1407088172
Name:CARMACK, ELIZABETH G (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:G
Last Name:CARMACK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:G
Other - Last Name:SHENK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:677 ROUTE 7A
Mailing Address - Street 2:
Mailing Address - City:SHAFTSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05262
Mailing Address - Country:US
Mailing Address - Phone:802-442-7300
Mailing Address - Fax:
Practice Address - Street 1:677 ROUTE 7A
Practice Address - Street 2:
Practice Address - City:SHAFTSBURY
Practice Address - State:VT
Practice Address - Zip Code:05262
Practice Address - Country:US
Practice Address - Phone:802-442-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-14
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016.00733621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice