Provider Demographics
NPI:1184725822
Name:MATHEWS, ELIZABETH LANDRY (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:LANDRY
Last Name:MATHEWS
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 1:4438 VIKING DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-7510
Mailing Address - Country:US
Mailing Address - Phone:318-747-2666
Mailing Address - Fax:318-747-6610
Practice Address - Street 1:4438 VIKING DR STE 100
Practice Address - Street 2:
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-7510
Practice Address - Country:US
Practice Address - Phone:318-747-2666
Practice Address - Fax:318-747-6610
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA49761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice