Provider Demographics
NPI:1831487990
Name:BOTELLO, ELIZABETH ANN (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:ANN
Last Name:BOTELLO
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 1:5850 FM 802
Mailing Address - Street 2:STE. C3
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-5203
Mailing Address - Country:US
Mailing Address - Phone:956-832-0050
Mailing Address - Fax:
Practice Address - Street 1:5850 FM 802
Practice Address - Street 2:STE. C3
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526-5203
Practice Address - Country:US
Practice Address - Phone:956-832-0050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2014-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX27181122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282194402Medicaid
TX282194409Medicaid