Provider Demographics
NPI:1861995375
Name:NEEDELS, ELIZABETH C (DDS)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:C
Last Name:NEEDELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 S BARRINGTON AVE APT 415
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-4423
Mailing Address - Country:US
Mailing Address - Phone:402-440-0420
Mailing Address - Fax:
Practice Address - Street 1:612 S BARRINGTON AVE APT 415
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-4423
Practice Address - Country:US
Practice Address - Phone:402-440-0420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-10
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
CADDS1071481223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program