1992796981 NPI number — DR. ELIZABETH ELLEN DULING DMD

Table of content: DR. ELIZABETH ELLEN DULING DMD (NPI 1992796981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992796981 NPI number — DR. ELIZABETH ELLEN DULING DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DULING
Provider First Name:
ELIZABETH
Provider Middle Name:
ELLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SCALA
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ELLEN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992796981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10205 N. RIVA RIDGE LOOP
Provider Second Line Business Mailing Address:
U.S. ARMY DENTAL ACTIVITY ATTN: CREDENTIALS
Provider Business Mailing Address City Name:
FT. DRUM
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
13602-5005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
315-772-4342
Provider Business Mailing Address Fax Number:
315-772-9692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10205 N. RIVA RIDGE LOOP
Provider Second Line Business Practice Location Address:
U.S. ARMY DENTAL ACTIVITY ATTN: CREDENTIALS
Provider Business Practice Location Address City Name:
FT. DRUM
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
13602-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-772-4342
Provider Business Practice Location Address Fax Number:
315-772-9692
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  052217-1 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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