Provider Demographics
NPI:1689713901
Name:ELLIOTT, RONALD DOUGLAS JR (DMD)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DOUGLAS
Last Name:ELLIOTT
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 605
Mailing Address - Street 2:265 MAIN ST
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41022
Mailing Address - Country:US
Mailing Address - Phone:859-371-4620
Mailing Address - Fax:859-746-5192
Practice Address - Street 1:265 MAIN ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41022
Practice Address - Country:US
Practice Address - Phone:859-371-4620
Practice Address - Fax:859-746-5192
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7616122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist