# MICHAEL D ELLIOTT DMD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386939148
- **Authorized official:** KRYSTLE WINKELMAN (MANAGER)
- **Authorized official phone:** (480) 833-8064

## Contact information

- **Practice address:** 564 W 9TH PL, SUITE ONE, MESA, AZ 85201-4069
- **Practice address phone:** (480) 833-8064
- **Practice address fax:** (480) 962-8263
- **Mailing address:** 564 W 9TH PL, SUITE ONE, MESA, AZ 85201-4069
- **Mailing address phone:** (480) 833-8064
- **Mailing address fax:** (480) 962-8263

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 2410 | AZ | Yes |

## Other

- **Enumeration date:** 06/09/2011
- **Last updated:** 06/09/2011