Provider Demographics
NPI:1467534289
Name:ELLIOTT, CATHERINE MARY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:MARY
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:MRS
Other - First Name:CATHERINE
Other - Middle Name:MARY
Other - Last Name:WOLFINGTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDH
Mailing Address - Street 1:8104 CEDAR CREEK DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-3844
Mailing Address - Country:US
Mailing Address - Phone:505-615-0951
Mailing Address - Fax:505-792-6737
Practice Address - Street 1:8104 CEDAR CREEK DR NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-3844
Practice Address - Country:US
Practice Address - Phone:505-615-0951
Practice Address - Fax:505-792-6737
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDH228124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist