Jordan Kane Elliott, DMD
Individual provider Active NPI Dentist · Ipswich, MA
NPI 1093569550 · NPPES record last updated Jun 12, 2024
Key facts
- NPI
- 1093569550
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- DN10000243 (MA)
- Practice address
- 146 High St Unit 1
Ipswich, MA 01938-1212 - Phone
- (978) 276-9990
- NPI assigned
- Apr 12, 2024
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN10000243 | MA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MA | ||
| Dentist | 122300000X | DN10000243 | MA | Yes |
Addresses
Primary practice location
146 High St Unit 1
Ipswich, MA 01938-1212
Mailing address
95 Hopkins St Apt 502
Wakefield, MA 01880-2269
Phone (617) 470-5696
Other providers in Ipswich, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.