Healthcare Provider Details

I. General information

NPI: 1609919083
Provider Name (Legal Business Name): JEREMY D ELLIOTT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 12/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 NOLENSVILLE RD SUITE 101
NASHVILLE TN
37211
US

IV. Provider business mailing address

5802 NOLENSVILLE RD SUITE 101
NASHVILLE TN
37211
US

V. Phone/Fax

Practice location:
  • Phone: 615-832-5899
  • Fax: 615-832-6905
Mailing address:
  • Phone: 615-832-5899
  • Fax: 615-832-6905

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDNO13441
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8397
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: