Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DN010980 | GA |
NPI | 1255466256 |
---|---|
Provider Name | Elizabeth C Lense |
First Address | Lawrenceville, GA 30045-0897 |
Second Address | Conyers, GA 30094-6619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 08/07/2007 |