Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 8381 | CT |
NPI | 1003017757 |
---|---|
Provider Name | Dr. Elizabeth Anne Dekker |
First Address | Sharon, CT 06069 |
Second Address | Sharon, CT 06069 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 08/07/2007 |