Provider Demographics
NPI:1497843395
Name:STOUFFER, ELIZABETH (DDS)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:
Last Name:STOUFFER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:STOUFFER
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:404 W SUPERIOR ST
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49348-1223
Mailing Address - Country:US
Mailing Address - Phone:269-792-9557
Mailing Address - Fax:269-792-4161
Practice Address - Street 1:404 W SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:WAYLAND
Practice Address - State:MI
Practice Address - Zip Code:49348-1223
Practice Address - Country:US
Practice Address - Phone:269-792-9557
Practice Address - Fax:269-792-4161
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI176311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice