Elizabeth E Williamson, DDS
Individual provider Active NPI General Practice Dentistry · Mira Loma, CA
NPI 1245497288 · NPPES record last updated May 19, 2008
Key facts
- NPI
- 1245497288
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 55914 (CA)
- Practice address
- 12571 Limonite Avenue
Suite 230
Mira Loma, CA 91752 - Phone
- (951) 360-3444
- Fax
- (951) 360-3784
- NPI assigned
- May 19, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 55914 | CA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dimitri Dental Corporation | General Practice | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 55914 | CA | Yes |
Addresses
Primary practice location
12571 Limonite Avenue
Suite 230
Mira Loma, CA 91752
Mailing address
2860 Michelle
2ND Floor
Irvine, CA 92606-1009
Phone (714) 368-2084
Other providers in Mira Loma, CA
All providers in Mira Loma, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 19, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.