# CORNERSTONE FAMILY & COSMETIC DENTISTRY

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

## Provider details

- **NPI number:** 1629295274
- **Authorized official:** DR. KEVIN M ELLIOTT DMD (PARTNER)
- **Authorized official phone:** (208) 634-5255

## Contact information

- **Practice address:** 143 EAST LAKE STREET, MCCALL, ID 83638
- **Practice address phone:** (208) 634-5255
- **Practice address fax:** (208) 634-1047
- **Mailing address:** PO BOX 1496, MCCALL, ID 83638
- **Mailing address phone:** (208) 634-5255
- **Mailing address fax:** (208) 634-1047

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D3280 | ID | — |
| 122300000X | Dentist | D3826 | ID | Yes |

## Other

- **Enumeration date:** 04/18/2007
- **Last updated:** 08/22/2020

## 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 |