Provider Demographics
NPI:1467434746
Name:DE AGUIRRE, ELIZABETH MARIE (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARIE
Last Name:DE AGUIRRE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 W 68TH ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-5446
Mailing Address - Country:US
Mailing Address - Phone:305-826-3255
Mailing Address - Fax:305-826-3898
Practice Address - Street 1:806 S DOUGLAS RD
Practice Address - Street 2:150
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3157
Practice Address - Country:US
Practice Address - Phone:305-446-2226
Practice Address - Fax:305-446-8458
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-14
Last Update Date:2017-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0015008122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001666800Medicaid
1003893363OtherNPI FOR EXPERT SMILES OFFICE
FL1225316888OtherNPI FOR GABLES OFFICE