Basic Information
| Provider Information | |||||||||
| NPI: | 1992796981 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DULING | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | ELLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DMD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | SCALA | ||||||||
| OtherFirstName: | ELIZABETH | ||||||||
| OtherMiddleName: | ELLEN | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 10205 N. RIVA RIDGE LOOP | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY ATTN: CREDENTIALS | ||||||||
| City: | FT. DRUM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136025005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157724342 | ||||||||
| FaxNumber: | 3157729692 | ||||||||
| Practice Location | |||||||||
| Address1: | 10205 N. RIVA RIDGE LOOP | ||||||||
| Address2: | U.S. ARMY DENTAL ACTIVITY ATTN: CREDENTIALS | ||||||||
| City: | FT. DRUM | ||||||||
| State: | NY | ||||||||
| PostalCode: | 136025005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3157724342 | ||||||||
| FaxNumber: | 3157729692 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 052217-1 | NY | Y | Dental Providers | Dentist |
No ID Information.