Provider Demographics
NPI:1821118795
Name:ELLIOT, JEFFREY F (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:F
Last Name:ELLIOT
Suffix:
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 1:7400 BRIGANTINE LN
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33067-1636
Mailing Address - Country:US
Mailing Address - Phone:954-752-1045
Mailing Address - Fax:954-344-9651
Practice Address - Street 1:9600 W SAMPLE RD
Practice Address - Street 2:SUITE 504
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4045
Practice Address - Country:US
Practice Address - Phone:954-360-6550
Practice Address - Fax:954-340-8488
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN114431223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU12735Medicare ID - Type Unspecified