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Organization
CORNERSTONE FAMILY & COSMETIC DENTISTRY
Active
Organization
CORNERSTONE FAMILY & COSMETIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEVIN M ELLIOTT DMD (PARTNER)
(208) 634-5255
Entity
Organization
Contact information
Practice address
143 EAST LAKE STREET, MCCALL, ID 83638
(208) 634-5255
(208) 634-1047
Mailing address
PO BOX 1496, MCCALL, ID 83638
(208) 634-5255
(208) 634-1047
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D3280
ID
122300000X
Dentist
Primary
D3826
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010155075
DR. NEWTON REGENCE BS
ID
01
—
00001156002
DR ELLIOTT REGENCE BS
ID
01
—
1913080
UNITED CONCORDIA
ID
01
—
6P003
DR. NEWTON BC BS
ID
01
—
6P005
DR ELLIOTT BC BS
ID
Enumeration date
04/18/2007
Last updated
08/22/2020
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