Individual
DR. ELIZABETH BLAVATSKY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.D.S.
Contact information
Practice address
422 S MAIN ST, LIVINGSTON, MT 59047-3456
(406) 222-6061
(406) 222-6062
Mailing address
422 S MAIN ST, LIVINGSTON, MT 59047-3456
(406) 222-6061
(406) 222-6062
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1835
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0130624
—
MT
01
—
5511051
CHIP
MT
Enumeration date
01/23/2007
Last updated
07/08/2007
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