Provider Demographics
NPI:1629295472
Name:CRISTOFANO, LIZ (DDS)
Entity Type:Individual
Prefix:DR
First Name:LIZ
Middle Name:
Last Name:CRISTOFANO
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 1:4526 W SWANN AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-3722
Mailing Address - Country:US
Mailing Address - Phone:813-802-8301
Mailing Address - Fax:813-944-3106
Practice Address - Street 1:4104 LITTLE RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1721
Practice Address - Country:US
Practice Address - Phone:813-802-8301
Practice Address - Fax:813-944-3106
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010082331223G0001X
FLDN161471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice