Provider Demographics
NPI:1730202524
Name:DEWEESE, ELIZABETH HANTO (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:HANTO
Last Name:DEWEESE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15229 N DALE MABRY HWY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-1823
Mailing Address - Country:US
Mailing Address - Phone:813-962-3396
Mailing Address - Fax:813-963-7668
Practice Address - Street 1:15229 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1823
Practice Address - Country:US
Practice Address - Phone:813-962-3396
Practice Address - Fax:813-963-7668
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16311122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist