Provider Demographics
NPI:1972545432
Name:ELLIOTT, MICHAEL BRANDON (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRANDON
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 1:254 9TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-3708
Mailing Address - Country:US
Mailing Address - Phone:352-514-5893
Mailing Address - Fax:
Practice Address - Street 1:321 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-3309
Practice Address - Country:US
Practice Address - Phone:561-832-1781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN175441223E0200X
MD151361223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics