Provider Demographics
NPI:1629233176
Name:JEREMY D. ELLIOTT D.M.D.
Entity Type:Organization
Organization Name:JEREMY D. ELLIOTT D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:D
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:615-832-5899
Mailing Address - Street 1:5802 NOLENSVILLE PIKE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-6520
Mailing Address - Country:US
Mailing Address - Phone:615-832-5899
Mailing Address - Fax:615-832-6905
Practice Address - Street 1:5802 NOLENSVILLE PIKE
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-6520
Practice Address - Country:US
Practice Address - Phone:615-832-5899
Practice Address - Fax:615-832-6905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000083971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty