Provider Demographics
NPI:1609934827
Name:GUBERNICK, ELIZABETH L (DDS)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:L
Last Name:GUBERNICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6239 E MARILYN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-2575
Mailing Address - Country:US
Mailing Address - Phone:602-561-6667
Mailing Address - Fax:
Practice Address - Street 1:1010 E MCDOWELL RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2606
Practice Address - Country:US
Practice Address - Phone:602-253-8332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD69771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice