Healthcare Provider Details

I. General information

NPI: 1265646053
Provider Name (Legal Business Name): DAVID H. ELLIOTT, II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 ALLEN ST
BELHAVEN NC
27810-1405
US

IV. Provider business mailing address

233 ALLEN ST
BELHAVEN NC
27810-1405
US

V. Phone/Fax

Practice location:
  • Phone: 252-943-6262
  • Fax:
Mailing address:
  • Phone: 252-943-6262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number7976
License Number StateNC

VIII. Authorized Official

Name: MR. DAVID H ELLIOTT
Title or Position: OWNER
Credential: DDS
Phone: 252-943-6262