Provider Demographics
NPI:1336443266
Name:ELLIOTT, JULIE JO (RDH)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:JO
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 VERMONT DR STE 210
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2900
Mailing Address - Country:US
Mailing Address - Phone:970-227-7202
Mailing Address - Fax:970-223-5259
Practice Address - Street 1:2000 VERMONT DR STE 210
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2900
Practice Address - Country:US
Practice Address - Phone:970-227-7202
Practice Address - Fax:970-223-5259
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-06
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO902945124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist