Provider Demographics
NPI:1619265907
Name:LANSFORD, ELIZABETH SUSAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:LANSFORD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:BETH
Other - Middle Name:SUSAN
Other - Last Name:MELENBRINK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4055 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3201
Mailing Address - Country:US
Mailing Address - Phone:314-541-2037
Mailing Address - Fax:
Practice Address - Street 1:4055 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3201
Practice Address - Country:US
Practice Address - Phone:314-541-2037
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-20
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028673122300000X
MO2012003057122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist