Healthcare Provider Details

I. General information

NPI: 1316057789
Provider Name (Legal Business Name): MICHAEL ROBERT ELLIOTT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: MICHAEL R ELLIOTT DDS

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 SPRUCE
DUNCAN OK
78533-2305
US

IV. Provider business mailing address

1615 SPRUCE
DUNCAN OK
78533-2305
US

V. Phone/Fax

Practice location:
  • Phone: 580-255-5752
  • Fax: 580-255-5752
Mailing address:
  • Phone: 580-255-5752
  • Fax: 580-255-5752

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3383
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: