Provider Demographics
NPI:1164121406
Name:ELLIOTT, JODI LYNN (RDH)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 SMOKY CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:TN
Mailing Address - Zip Code:37865-3906
Mailing Address - Country:US
Mailing Address - Phone:316-650-5482
Mailing Address - Fax:
Practice Address - Street 1:949 DOLLY PARTON PKWY
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3723
Practice Address - Country:US
Practice Address - Phone:865-453-2890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10209124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist