Provider Demographics
NPI:1003807678
Name:ELROD, JAMES R (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:ELROD
Suffix:
Gender:M
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:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:GREENBACK
Mailing Address - State:TN
Mailing Address - Zip Code:37742-0126
Mailing Address - Country:US
Mailing Address - Phone:865-856-2320
Mailing Address - Fax:865-856-9103
Practice Address - Street 1:1761 HIGHWAY 95 S
Practice Address - Street 2:
Practice Address - City:GREENBACK
Practice Address - State:TN
Practice Address - Zip Code:37742-4245
Practice Address - Country:US
Practice Address - Phone:865-856-2320
Practice Address - Fax:865-856-9103
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-02
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS28211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice