MEDICARE: DR. LARRY F. ELLIOTT DDS, MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	3746	FL

General Provider Information

NPI Number	:	1942411707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LARRY F. ELLIOTT DDS, MS

Provider Business Mailing Address
First Line	:	1825 NE 45TH ST
Second Line	:	SUITE B
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5117
Country	:	US
Telephone Number	:	954-772-1600
Fax Number	:	954-772-6622

Provider Business Practice Location Address
First Line	:	1825 NE 45TH ST
Second Line	:	SUITE B
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33308-5117
Country	:	US
Telephone Number	:	954-772-1600
Fax Number	:	954-772-6622

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2007
Last Update Date	:	07/08/2007

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