Provider Demographics
NPI:1700555000
Name:ELIZAN, BRIDGET ANN G (DMD)
Entity Type:Individual
Prefix:
First Name:BRIDGET ANN
Middle Name:G
Last Name:ELIZAN
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 1:7745 WOLF WOOD CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89179-2080
Mailing Address - Country:US
Mailing Address - Phone:702-277-4611
Mailing Address - Fax:
Practice Address - Street 1:3375 E TROPICANA AVE STE F8
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-7357
Practice Address - Country:US
Practice Address - Phone:702-964-3626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-09
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD011169122300000X
NV7710122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist