Provider Demographics
NPI:1902936966
Name:JAY ELLIOTT D D S PA
Entity Type:Organization
Organization Name:JAY ELLIOTT D D S PA
Other - Org Name:NEW TEETH IMPLANT & DENTURE SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:E
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:713-644-4331
Mailing Address - Street 1:4005 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77087-4703
Mailing Address - Country:US
Mailing Address - Phone:713-644-4331
Mailing Address - Fax:713-644-1975
Practice Address - Street 1:4005 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77087-4703
Practice Address - Country:US
Practice Address - Phone:713-644-4331
Practice Address - Fax:713-644-1975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty