Kevin M Elliott

Primary specialty

DentistTaxonomy code 122300000X

License

D3826 Issued in ID

Legal business name

KEVIN M ELLIOTT

Practice address

327 Deinhard LN
McCall, ID 83638-4703

Phone

(208) 634-1214

NPI assigned

Jun 23, 2009

Last updated

Jun 23, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kevin Michael Elliott

Title

D.M.D.

Phone

(208) 634-1214

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1245715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245715200000",
    "number": "1184852758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 990",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836380990",
            "telephone_number": "208-634-1214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "327 DEINHARD LN",
            "city": "MCCALL",
            "state": "ID",
            "postal_code": "836384703",
            "telephone_number": "208-634-1214"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KEVIN M ELLIOTT",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-06-23",
        "last_updated": "2009-06-23",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "D.M.D.",
        "authorized_official_telephone_number": "208-634-1214",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D3826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in McCall, ID
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.