Provider Demographics
NPI:1356692560
Name:PARE, ELIZABETH ASHLEY (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ASHLEY
Last Name:PARE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 SW CHAMBER CT
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3413
Mailing Address - Country:US
Mailing Address - Phone:772-336-8478
Mailing Address - Fax:877-770-0949
Practice Address - Street 1:150 SW CHAMBER CT
Practice Address - Street 2:SUITE 201
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3413
Practice Address - Country:US
Practice Address - Phone:772-335-0993
Practice Address - Fax:772-335-8192
Is Sole Proprietor?:No
Enumeration Date:2012-09-27
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19911122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist