Provider Demographics
NPI:1568401198
Name:NELSON, ELIZABETH CRAFT (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:CRAFT
Last Name:NELSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 MAPLEVILLE DEPOT
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-1937
Mailing Address - Country:US
Mailing Address - Phone:802-524-5169
Mailing Address - Fax:802-527-7184
Practice Address - Street 1:1 MAPLEVILLE DEPOT
Practice Address - Street 2:SUITE ONE
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-1937
Practice Address - Country:US
Practice Address - Phone:802-524-5169
Practice Address - Fax:802-527-7184
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT016-00020031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice