Provider Demographics
NPI:1548304132
Name:ELLIOTT, JAMES E (DDS)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:E
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 1:10 S BELVEDERE BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3706
Mailing Address - Country:US
Mailing Address - Phone:901-276-7042
Mailing Address - Fax:901-276-7049
Practice Address - Street 1:10 S BELVEDERE BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3706
Practice Address - Country:US
Practice Address - Phone:901-276-7042
Practice Address - Fax:901-276-7049
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN005260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist