Elison Dental Center

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D3605 Issued in ID

Legal business name

ELISON DENTAL CENTER

Practice address

3656 Washington Pkwy
Idaho Falls, ID 83404-7573

Phone

(208) 522-7216

NPI assigned

Jun 3, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Michael Aaron Elison, DMD

Title

President

Phone

(208) 522-7216

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1212451200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1212451200000",
    "number": "1932368222",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3656 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047573",
            "telephone_number": "208-522-7216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3656 WASHINGTON PKWY",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834047573",
            "telephone_number": "208-522-7216"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELISON DENTAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-03",
        "last_updated": "2008-06-03",
        "status": "A",
        "authorized_official_last_name": "ELISON",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-522-7216",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3605",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "806380000",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Samantha Eitelgeorge
• Elevate Academy East Idaho
• Elevate Anesthesia LLC
• Elevated Healing Services LLC
• Elevation Counseling
• Elison Oral and Maxillofacial Surgery
• Elison Orthodontics PLLC
• Joseph Hyrum Elison, DDSMS
• Joseph Matthew Elison, DDSMS
• Michael Aaron Elison, DMD

• General Practice Dentistry in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2008; 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.