Provider Demographics
NPI:1982915500
Name:RECTOR, ELIZABETH GOLD (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GOLD
Last Name:RECTOR
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 1:4200 BRYANT IRVIN RD STE 129
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-4212
Mailing Address - Country:US
Mailing Address - Phone:817-731-6964
Mailing Address - Fax:
Practice Address - Street 1:4200 BRYANT IRVIN RD
Practice Address - Street 2:SUITE 129
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109
Practice Address - Country:US
Practice Address - Phone:817-731-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25597122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3031908Medicaid