Provider Demographics
NPI:1013140359
Name:ELLIOTT, JASON P (DDS)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:P
Last Name:ELLIOTT
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 1:809 N HAMMONDS FERRY RD
Mailing Address - Street 2:
Mailing Address - City:LINTHICUM
Mailing Address - State:MD
Mailing Address - Zip Code:21090-1341
Mailing Address - Country:US
Mailing Address - Phone:410-789-6111
Mailing Address - Fax:410-789-6446
Practice Address - Street 1:809 N HAMMONDS FERRY RD
Practice Address - Street 2:
Practice Address - City:LINTHICUM
Practice Address - State:MD
Practice Address - Zip Code:21090-1341
Practice Address - Country:US
Practice Address - Phone:410-789-6111
Practice Address - Fax:410-789-6446
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD128151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice