Provider Demographics
NPI:1609919083
Name:ELLIOTT, JEREMY D (DMD)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:D
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 NOLENSVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211
Mailing Address - Country:US
Mailing Address - Phone:615-832-5899
Mailing Address - Fax:615-832-6905
Practice Address - Street 1:5802 NOLENSVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211
Practice Address - Country:US
Practice Address - Phone:615-832-5899
Practice Address - Fax:615-832-6905
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO134411223G0001X
TN83971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice