Provider Demographics
NPI:1205118080
Name:PICARD, ELIZABETH MARY (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARY
Last Name:PICARD
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 1:110 E. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-5730
Mailing Address - Country:US
Mailing Address - Phone:989-892-9888
Mailing Address - Fax:989-892-8837
Practice Address - Street 1:916 WASHINGTON AVE
Practice Address - Street 2:STE 202
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-5730
Practice Address - Country:US
Practice Address - Phone:989-892-9888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE6984122300000X
CO2019501223P0221X
MI29010212081223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist