Michael D Elliott DMD PC

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

2410 Issued in AZ

Legal business name

MICHAEL D ELLIOTT DMD PC

Practice address

564 W 9TH PL
Suite One
Mesa, AZ 85201-4069

Phone

(480) 833-8064

Fax

(480) 962-8263

NPI assigned

Jun 9, 2011

Last updated

Jun 9, 2011By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Krystle Winkelman

Title

Manager

Phone

(480) 833-8064

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1307577600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1307577600000",
    "number": "1386939148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "564 W 9TH PL",
            "address_2": "SUITE ONE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852014069",
            "telephone_number": "480-833-8064",
            "fax_number": "480-962-8263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "564 W 9TH PL",
            "address_2": "SUITE ONE",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852014069",
            "telephone_number": "480-833-8064",
            "fax_number": "480-962-8263"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL D ELLIOTT DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-09",
        "last_updated": "2011-06-09",
        "status": "A",
        "authorized_official_last_name": "WINKELMAN",
        "authorized_official_first_name": "KRYSTLE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "480-833-8064"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "2410",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "083353",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "2410",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Oral and Maxillofacial Surgery (Dentist) in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Oral and Maxillofacial Surgery (Dentist) in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.