Provider Demographics
NPI:1700082138
Name:ELLIFF, ANDREW FRANKLIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:FRANKLIN
Last Name:ELLIFF
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 CARROLL DR
Mailing Address - Street 2:
Mailing Address - City:PONTOON BEACH
Mailing Address - State:IL
Mailing Address - Zip Code:62040-6633
Mailing Address - Country:US
Mailing Address - Phone:618-540-4563
Mailing Address - Fax:
Practice Address - Street 1:500 FULLERTON RD
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2970
Practice Address - Country:US
Practice Address - Phone:618-355-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019027402122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist