Provider Demographics
NPI:1265544522
Name:ELLIOTT, GREGORY E (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:E
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 1:37226 KINGSBURN CT
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-4072
Mailing Address - Country:US
Mailing Address - Phone:734-432-7353
Mailing Address - Fax:
Practice Address - Street 1:20704 GILL RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48335-5230
Practice Address - Country:US
Practice Address - Phone:248-473-2000
Practice Address - Fax:248-473-9286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI142191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice