Provider Demographics
NPI:1881602878
Name:ELLIOTT, PAUL STEWART (DMD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:STEWART
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1 PARK LANE CENTER
Mailing Address - Street 2:
Mailing Address - City:DOUGLASSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19518
Mailing Address - Country:US
Mailing Address - Phone:610-385-7403
Mailing Address - Fax:610-385-7558
Practice Address - Street 1:1 PARK LANE CENTER
Practice Address - Street 2:
Practice Address - City:DOUGLASSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19518
Practice Address - Country:US
Practice Address - Phone:610-385-7403
Practice Address - Fax:610-385-7558
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025325L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery