Edious K. Elliot, DMD

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

DS040658 Issued in PA

Practice address

8240 Cazenovia Rd Ste 60
Manlius, NY 13104-8814

Phone

(315) 692-6546

Fax

(315) 692-0449

NPI assigned

Jul 5, 2012

Last updated

Jul 6, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Fayetteville-Manlius Oral Surgery, P.C

  • Oral and Maxillofacial Surgery (Dentist)
  • Manlius, NY
  • NPI 1649848458
  NPD Authorized official

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

{
    "created_epoch": "1341446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1625529600000",
    "number": "1639434665",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8240 CAZENOVIA RD STE 60",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131048814",
            "telephone_number": "315-692-6546",
            "fax_number": "315-692-0449"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8240 CAZENOVIA RD STE 60",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131048814",
            "telephone_number": "315-692-6546",
            "fax_number": "315-692-0449"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOT",
        "first_name": "EDIOUS",
        "middle_name": "K.",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-07-05",
        "last_updated": "2021-07-06",
        "certification_date": "2021-07-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI02507400",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "PA",
            "license": "DA031767",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "PA",
            "license": "DS040658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald M. Dixon
• Carolyn Bradford Dragon, DMD, MSD
• Darcey A Dwelly, LPN
• Henry M. Eisenberg, M.D.
• Khadija Elharti
• Stacey Patricia Elliott, D.O.
• Andrea P Ellis, RN
• Peter H Emery Jr., RPH
• Patricia D Endy, RD
• Charlotte Giovanna Ennis, DPT

• Oral and Maxillofacial Surgery (Dentist) in Manlius, NY
• Providers in Manlius, NY by specialty
• Oral and Maxillofacial Surgery (Dentist) in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.