Provider Demographics
NPI:1083753313
Name:ELLIOTT, MICHAEL P (DMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1831
Mailing Address - Country:US
Mailing Address - Phone:859-331-8898
Mailing Address - Fax:859-331-9201
Practice Address - Street 1:3211 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1831
Practice Address - Country:US
Practice Address - Phone:859-331-8898
Practice Address - Fax:859-331-9201
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist