Provider Demographics
NPI:1275794463
Name:ELLIOTT, DOUGLAS J
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:J
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LOOP RD
Mailing Address - Street 2:
Mailing Address - City:MERRIMACK
Mailing Address - State:NH
Mailing Address - Zip Code:03054-3659
Mailing Address - Country:US
Mailing Address - Phone:603-424-1199
Mailing Address - Fax:603-424-5566
Practice Address - Street 1:27 LOOP RD
Practice Address - Street 2:
Practice Address - City:MERRIMACK
Practice Address - State:NH
Practice Address - Zip Code:03054-3659
Practice Address - Country:US
Practice Address - Phone:603-424-1199
Practice Address - Fax:603-424-5566
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH33881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics