Provider Demographics
NPI:1255501854
Name:JASON PAUL ELLIOTT DDS LLC
Entity Type:Organization
Organization Name:JASON PAUL ELLIOTT DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-622-3180
Mailing Address - Street 1:1202 HARBOR ISLAND WALK
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5460
Mailing Address - Country:US
Mailing Address - Phone:443-622-3180
Mailing Address - Fax:
Practice Address - Street 1:809 N HAMMONDS FERRY RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-1317
Practice Address - Country:US
Practice Address - Phone:410-789-6111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD12815261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental