Provider Demographics
NPI:1467701003
Name:CLAPHAM, ELIZABETH LARSON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LARSON
Last Name:CLAPHAM
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 1:9030 SOUTHWESTERN BLVD
Mailing Address - Street 2:#3336
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-6235
Mailing Address - Country:US
Mailing Address - Phone:919-475-7242
Mailing Address - Fax:
Practice Address - Street 1:9030 SOUTHWESTERN BLVD
Practice Address - Street 2:#3336
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-2236
Practice Address - Country:US
Practice Address - Phone:919-475-7242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-29
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32480122300000X
NC93921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice