Provider Demographics
NPI:1053603894
Name:STAVES, ELIZABETH J (DDS, PA)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:J
Last Name:STAVES
Suffix:
Gender:F
Credentials:DDS, PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5310 4TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-2916
Mailing Address - Country:US
Mailing Address - Phone:727-526-5900
Mailing Address - Fax:727-526-5944
Practice Address - Street 1:5310 4TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33703-2916
Practice Address - Country:US
Practice Address - Phone:727-526-5900
Practice Address - Fax:727-526-5944
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-12
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 139431223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry