NPIMap

Organization Active NPI

Cornerstone Family & Cosmetic Dentistry

  • General Practice Dentistry
  • Cascade, ID
National Provider Identifier
1962629527
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D3280 Issued in ID
Legal business name
CORNERSTONE FAMILY & COSMETIC DENTISTRY
Practice address
220 South Main Street
Cascade, ID 83611
Phone
(208) 382-3558
Fax
(208) 382-3668
NPI assigned
Apr 18, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Kevin M Elliott, DMDNPI 1104910199
Title
Partner
Phone
(208) 382-3558

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D3826 OH
General Practice Dentistry 1223G0001X D3280 ID Primary

Addresses

Primary practice location

220 South Main Street
Cascade, ID 83611

Mailing address

PO Box 498
Cascade, ID 83611-0498
Phone (208) 382-3558

Other identifiers 4

IdentifierTypeStateIssuer
6P003OtherIDDR NEWTON BC BS
000010155075OtherIDDR NEWTON REGENCE BS
6P005OtherIDDR. ELLIOTT BC BS
000010156002OtherIDDR ELLIOTT REGENCE BS

National Provider Directory

National Provider Directory
Tax ID family
Cornerstone Family Cosmetic Dentistry2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

220 S Main St
Cascade, ID 83611
Phone (208) 382-3558

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962629527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 498",
            "city": "CASCADE",
            "state": "ID",
            "postal_code": "836110498",
            "telephone_number": "208-382-3558",
            "fax_number": "208-382-3668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 SOUTH MAIN STREET",
            "city": "CASCADE",
            "state": "ID",
            "postal_code": "83611",
            "telephone_number": "208-382-3558",
            "fax_number": "208-382-3668"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE FAMILY & COSMETIC DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ELLIOTT",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PARTNER",
        "authorized_official_telephone_number": "208-382-3558",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "D3826",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D3280",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR NEWTON BC BS",
            "identifier": "6P003",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR NEWTON REGENCE BS",
            "identifier": "000010155075",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR. ELLIOTT BC BS",
            "identifier": "6P005",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DR ELLIOTT REGENCE BS",
            "identifier": "000010156002",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cascade, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.