Provider Demographics
NPI:1104139922
Name:NG, ELLIOT (DDS)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:NONE
Other - Middle Name:
Other - Last Name:NONE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:8609 JUSTICE AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4555
Mailing Address - Country:US
Mailing Address - Phone:718-271-0303
Mailing Address - Fax:
Practice Address - Street 1:8609 JUSTICE AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4555
Practice Address - Country:US
Practice Address - Phone:718-271-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice