Provider Demographics
NPI:1265646053
Name:DAVID H. ELLIOTT, II
Entity Type:Organization
Organization Name:DAVID H. ELLIOTT, II
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:H
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-943-6262
Mailing Address - Street 1:233 ALLEN ST
Mailing Address - Street 2:
Mailing Address - City:BELHAVEN
Mailing Address - State:NC
Mailing Address - Zip Code:27810-1405
Mailing Address - Country:US
Mailing Address - Phone:252-943-6262
Mailing Address - Fax:
Practice Address - Street 1:233 ALLEN ST
Practice Address - Street 2:
Practice Address - City:BELHAVEN
Practice Address - State:NC
Practice Address - Zip Code:27810-1405
Practice Address - Country:US
Practice Address - Phone:252-943-6262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7976302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5901560Medicaid