Provider Demographics
NPI:1962653592
Name:ELLIOTT, DAVID F (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:F
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:10 S NEW PROSPECT RD
Mailing Address - Street 2:SUITE 23
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-1645
Mailing Address - Country:US
Mailing Address - Phone:732-364-3322
Mailing Address - Fax:732-364-7922
Practice Address - Street 1:10 S NEW PROSPECT RD
Practice Address - Street 2:SUITE 23
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-1645
Practice Address - Country:US
Practice Address - Phone:732-364-3322
Practice Address - Fax:732-364-7922
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DIO16528001223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics