Provider Demographics
NPI:1942563614
Name:BURNS, ELLIOTT TAYLOR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ELLIOTT
Middle Name:TAYLOR
Last Name:BURNS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:461 WINDSOR PARK RD
Mailing Address - Street 2:
Mailing Address - City:KERNERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27284-7014
Mailing Address - Country:US
Mailing Address - Phone:336-816-1027
Mailing Address - Fax:
Practice Address - Street 1:4010 PARK RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-2272
Practice Address - Country:US
Practice Address - Phone:704-525-3939
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC92871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice