Individual ProviderElizabeth BlavatskyDentistDental ProvidersPractice Address422 S Main St, Livingston, MT 59047-3456(406) 222-6061PECOS EnrollmentBased on the most recent information from CMS, provider Elizabeth Blavatsky does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1679627699Provider TypeIndividualFull NameBlavatsky, ElizabethTitleDr.CredentialD.D.S.GenderFemaleSole ProprietorNoEnumeration Date1/23/2007Last Updated7/8/2007Contact InformationPractice LocationPractice Address422 S Main St, Livingston, MT 59047-3456Phone(406) 222-6061Fax(406) 222-6062Mailing LocationMailing Address422 S Main St, Livingston, MT 59047-3456Phone(406) 222-6061Fax(406) 222-6062Provider TaxonomiesCodeDescriptionLicenseCode1223G0001XPrimaryDescriptionDentistDental ProvidersLicense1835MontanaProvider IdentifiersIDDescriptionIssuerID0130624DescriptionMedicaidIssuerUnlistedMontanaID5511051DescriptionOtherIssuerCHIPMontana