Provider Demographics
NPI:1679788087
Name:WAKHAM, ELIZABETH C ARWILE (DMD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:C ARWILE
Last Name:WAKHAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:ELIZABETH
Other - Middle Name:CARWILE
Other - Last Name:EUSTICE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1319 MILL CIR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-2934
Mailing Address - Country:US
Mailing Address - Phone:228-875-3137
Mailing Address - Fax:
Practice Address - Street 1:150 G E OHR ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4228
Practice Address - Country:US
Practice Address - Phone:228-432-7027
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2138-851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice