Healthcare Provider Details

I. General information

NPI: 1871609230
Provider Name (Legal Business Name): ELLIOTT ORTHODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 LOOP RD
MERRIMACK NH
03054-3659
US

IV. Provider business mailing address

27 LOOP RD
MERRIMACK NH
03054-3659
US

V. Phone/Fax

Practice location:
  • Phone: 603-424-1199
  • Fax:
Mailing address:
  • Phone: 603-424-1199
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3388
License Number StateNH

VIII. Authorized Official

Name: DR. DOUGLAS J ELLIOTT
Title or Position: OWNER
Credential: DMD, MDS
Phone: 603-424-1199