Provider Demographics
NPI:1669728788
Name:KLANDERMAN, ELIZABETH ASHLEE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ASHLEE
Last Name:KLANDERMAN
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 1:1776 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-3836
Mailing Address - Country:US
Mailing Address - Phone:904-203-2335
Mailing Address - Fax:
Practice Address - Street 1:1776 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-3836
Practice Address - Country:US
Practice Address - Phone:904-203-2335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.029153122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist