Provider Demographics
NPI:1679650717
Name:ELLIOTT, SHANA G (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:G
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4205 NORTH POINT PARKWAY
Mailing Address - Street 2:BLDG E
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30022
Mailing Address - Country:US
Mailing Address - Phone:770-475-4449
Mailing Address - Fax:770-569-0945
Practice Address - Street 1:4205 NORTH POINT PARKWAY
Practice Address - Street 2:BLDG E
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30022
Practice Address - Country:US
Practice Address - Phone:770-475-4449
Practice Address - Fax:770-569-0945
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA010314122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist