# KEVIN M ELLIOTT

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1184852758
- **Authorized official:** DR. KEVIN MICHAEL ELLIOTT (D.M.D.)
- **Authorized official phone:** (208) 634-1214

## Contact information

- **Practice address:** 327 DEINHARD LN, MCCALL, ID 83638-4703
- **Practice address phone:** (208) 634-1214
- **Mailing address:** PO BOX 990, MCCALL, ID 83638-0990
- **Mailing address phone:** (208) 634-1214

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3826 | ID | Yes |

## Other

- **Enumeration date:** 06/23/2009
- **Last updated:** 06/23/2009