Provider Demographics
NPI:1689740920
Name:ELLIOTT, BYRON KEITH (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:KEITH
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E WATAUGA AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4628
Mailing Address - Country:US
Mailing Address - Phone:423-232-5770
Mailing Address - Fax:423-232-5771
Practice Address - Street 1:122 E WATAUGA AVE
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37601-4628
Practice Address - Country:US
Practice Address - Phone:423-232-5770
Practice Address - Fax:423-232-5771
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70261223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics