Provider Demographics
NPI:1801057856
Name:ELLIOTT, MAXWELL CHRISTOPHER (DDS)
Entity type:Individual
Prefix:DR
First Name:MAXWELL
Middle Name:CHRISTOPHER
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 1:1915 FM 517 RD E
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:TX
Mailing Address - Zip Code:77539-8652
Mailing Address - Country:US
Mailing Address - Phone:281-534-7112
Mailing Address - Fax:281-534-1808
Practice Address - Street 1:1915 FM 517 RD E
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:TX
Practice Address - Zip Code:77539-8652
Practice Address - Country:US
Practice Address - Phone:281-534-7112
Practice Address - Fax:281-534-1808
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist