Provider Demographics
NPI:1780311613
Name:AMOFF, ELIZABETH (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:AMOFF
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:697 FRIARGATE CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5624
Mailing Address - Country:US
Mailing Address - Phone:904-884-1198
Mailing Address - Fax:
Practice Address - Street 1:2771 MONUMENT RD STE 21
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-3514
Practice Address - Country:US
Practice Address - Phone:904-641-3732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN274051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice