Provider Demographics
NPI:1588207591
Name:ELLIOT ROAD DENTAL PLLC
Entity Type:Organization
Organization Name:ELLIOT ROAD DENTAL PLLC
Other - Org Name:DO GOOD DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GASKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:2010 E ELLIOT RD STE 105
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1790
Mailing Address - Country:US
Mailing Address - Phone:480-839-7996
Mailing Address - Fax:
Practice Address - Street 1:2010 E ELLIOT RD STE 105
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85284-1790
Practice Address - Country:US
Practice Address - Phone:480-839-7996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-22
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty