Provider Demographics
NPI:1407622780
Name:MESHANKO, ELIZABETH MARIE (RDH, PHDH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:MESHANKO
Suffix:
Gender:F
Credentials:RDH, PHDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRADY
Mailing Address - State:PA
Mailing Address - Zip Code:16028-1017
Mailing Address - Country:US
Mailing Address - Phone:724-290-6471
Mailing Address - Fax:
Practice Address - Street 1:943 4TH AVE
Practice Address - Street 2:
Practice Address - City:NEW KENSINGTON
Practice Address - State:PA
Practice Address - Zip Code:15068-6409
Practice Address - Country:US
Practice Address - Phone:724-335-3334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH068384124Q00000X
PAPHDH001273124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist