Provider Demographics
NPI:1902214786
Name:TEA, ELIZABETH CLAIRE (DMD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:TEA
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 1:8722 CYPRESS SQUARE CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2305
Mailing Address - Country:US
Mailing Address - Phone:832-687-8321
Mailing Address - Fax:
Practice Address - Street 1:2323 WIRT RD
Practice Address - Street 2:STE F-1
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1232
Practice Address - Country:US
Practice Address - Phone:832-687-8321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-24
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist