1679788087 NPI number — DR. ELIZABETH C ARWILE WAKHAM D.M.D.

Table of content: DR. ELIZABETH C ARWILE WAKHAM D.M.D. (NPI 1679788087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679788087 NPI number — DR. ELIZABETH C ARWILE WAKHAM D.M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAKHAM
Provider First Name:
ELIZABETH
Provider Middle Name:
C ARWILE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EUSTICE
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
CARWILE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1679788087
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:
1319 MILL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OCEAN SPRINGS
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39564-2934
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
228-875-3137
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
150 G E OHR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILOXI
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39530-4228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-432-7027
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/11/2007

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: 1223G0001X , with the licence number:  2138-85 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com