Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | DN 13943 | FL |
NPI | 1053603894 |
---|---|
Provider Name | Dr. Elizabeth J. Staves |
First Address | St Petersburg, FL 33703-2916 |
Second Address | St Petersburg, FL 33703-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2011 |
Last Update Date | 12/05/2011 |