Provider Demographics
NPI:1942411707
Name:ELLIOTT, LARRY F (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:F
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:1825 NE 45TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-5117
Mailing Address - Country:US
Mailing Address - Phone:954-772-1600
Mailing Address - Fax:954-772-6622
Practice Address - Street 1:1825 NE 45TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-5117
Practice Address - Country:US
Practice Address - Phone:954-772-1600
Practice Address - Fax:954-772-6622
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL37461223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics