Provider Demographics
NPI:1841338118
Name:ELLIOTT, ANITA W (DDS)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:W
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:W
Other - Last Name:ELLIOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3435 E ROCKY SLOPE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7091
Mailing Address - Country:US
Mailing Address - Phone:480-759-6660
Mailing Address - Fax:480-759-6661
Practice Address - Street 1:2987 W ELLIOT RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224
Practice Address - Country:US
Practice Address - Phone:480-963-6300
Practice Address - Fax:480-963-8499
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ39021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice