Provider Demographics
NPI:1811741002
Name:BLACKMAN, ELISABETH GRANT (DDS)
Entity type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:GRANT
Last Name:BLACKMAN
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 1:2511 CLOISTER DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28211-3915
Mailing Address - Country:US
Mailing Address - Phone:704-957-2161
Mailing Address - Fax:
Practice Address - Street 1:8528 PIT STOP CT NW STE 30
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-8221
Practice Address - Country:US
Practice Address - Phone:704-286-1794
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC136791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice