Provider Demographics
NPI:1720112220
Name:DREYER, LIZETTE ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:LIZETTE
Middle Name:ANN
Last Name:DREYER
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 1:3503 13TH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-4054
Mailing Address - Country:US
Mailing Address - Phone:407-957-5344
Mailing Address - Fax:407-957-5473
Practice Address - Street 1:3503 13TH ST
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-4054
Practice Address - Country:US
Practice Address - Phone:407-957-5344
Practice Address - Fax:407-957-5473
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0116541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice