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General NPI Number Information
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NPI Number | 1346229317
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Entity Type | Individual
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Provider Name | SHAUN ELLIOTT DMD
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Gender | Male
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 04/18/2024
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Provider Practice Location Address
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Address Line | 100 DAWSON COMMONS CIR SUITE 110
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City | DAWSONVILLE
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State | GA
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Zip | 30534-6264
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Country | US
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Telephone | 706-265-1512
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Fax |
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Provider Business Mailing Address
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Address Line | 718 WAMOCK DR
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City | ALPHARETTA
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State | GA
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Zip | 30004-0774
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DNO12780
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DNO12780
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License Number State | GA
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