Thomas Jerry Elliott Sr., D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12008852 Issued in IN

Practice address

17 West Jackson St.
Cicero, IN 46034

Phone

(317) 984-5676

Fax

(317) 984-5677

NPI assigned

Jan 30, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Thomas J Elliott D.D.S. , P.C

  • Dental Clinic/Center
  • Cicero, IN
  • NPI 1013509934
  NPD Authorized official

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

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1689710170",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 WEST JACKSON ST.",
            "city": "CICERO",
            "state": "IN",
            "postal_code": "46034",
            "telephone_number": "317-984-5676",
            "fax_number": "317-984-5677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17 WEST JACKSON ST.",
            "city": "CICERO",
            "state": "IN",
            "postal_code": "46034",
            "telephone_number": "317-984-5676",
            "fax_number": "317-984-5677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ELLIOTT",
        "first_name": "THOMAS",
        "middle_name": "JERRY",
        "name_prefix": "Dr.",
        "name_suffix": "Sr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cicero Family Dental LLC
• Cicero Volunteer Fire Dept Inc
• Stacey Clevenger, CMT
• Days Healthy Living Pharmacy LLC (Days Healthy Living Pharmacy)
• Megan Jane Eaton, DO
• Jeremy G Fisk, MD
• Gabriel Associates Inc. (Cicero Counseling & Wellness Center)
• Melissa J Harding, FNP
• Charles R Harris, M.D.
• Douglas Michael Hartley, D.D.S.

• General Practice Dentistry in Cicero, IN
• Providers in Cicero, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.