Organization
MICHAEL D ELLIOTT DMD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTLE WINKELMAN (MANAGER)
(480) 833-8064
Entity
Organization
Contact information
Practice address
564 W 9TH PL, SUITE ONE, MESA, AZ 85201-4069
(480) 833-8064
(480) 962-8263
Mailing address
564 W 9TH PL, SUITE ONE, MESA, AZ 85201-4069
(480) 833-8064
(480) 962-8263
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
2410
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
083353
—
AZ
01
—
2410
DENTAL LICENSE
AZ
Enumeration date
06/09/2011
Last updated
06/09/2011
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