Provider Demographics
NPI:1164645941
Name:ELCOCK, STEVEN CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CHARLES
Last Name:ELCOCK
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 1:6535 W CAMELBACK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85033-1608
Mailing Address - Country:US
Mailing Address - Phone:623-848-1201
Mailing Address - Fax:623-848-1236
Practice Address - Street 1:6535 W CAMELBACK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85033-1608
Practice Address - Country:US
Practice Address - Phone:623-848-1201
Practice Address - Fax:623-848-1236
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD16951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice