Provider Demographics
NPI:1437789625
Name:NISS, ELIZABETH FRANCES (DDS, MS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:FRANCES
Last Name:NISS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 N FORMOSA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-1944
Mailing Address - Country:US
Mailing Address - Phone:323-842-8486
Mailing Address - Fax:
Practice Address - Street 1:20933 DEVONSHIRE ST STE 103
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2393
Practice Address - Country:US
Practice Address - Phone:323-842-8486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-16
Last Update Date:2024-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT12880390200000X
CA1061261223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program