Provider Demographics
NPI:1265562698
Name:ELLIOTT, IAN (DDS)
Entity type:Individual
Prefix:DR
First Name:IAN
Middle Name:
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 1:1315 MACOM DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9358
Mailing Address - Country:US
Mailing Address - Phone:630-862-3600
Mailing Address - Fax:630-862-3636
Practice Address - Street 1:1315 MACOM DR
Practice Address - Street 2:SUITE 106
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9358
Practice Address - Country:US
Practice Address - Phone:630-862-3600
Practice Address - Fax:630-862-3636
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics