Provider Demographics
NPI:1740393479
Name:ARCHER, ELIZABETH V (DMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:V
Last Name:ARCHER
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 1:838 BEAVER DAM RD
Mailing Address - Street 2:
Mailing Address - City:POINT PLEASANT BORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08742-3845
Mailing Address - Country:US
Mailing Address - Phone:732-899-4420
Mailing Address - Fax:732-899-4430
Practice Address - Street 1:838 BEAVER DAM RD
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT BORO
Practice Address - State:NJ
Practice Address - Zip Code:08742-3845
Practice Address - Country:US
Practice Address - Phone:732-899-4420
Practice Address - Fax:732-899-4430
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22004001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME432307099Medicaid