Provider Demographics
NPI:1972061984
Name:PAULSEN, ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:PAULSEN
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 1:5943 CANYON RESERVE HTS
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-6529
Mailing Address - Country:US
Mailing Address - Phone:415-990-6229
Mailing Address - Fax:
Practice Address - Street 1:4515 BROADMOOR BLUFFS DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8647
Practice Address - Country:US
Practice Address - Phone:719-900-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.026057122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392796Medicaid