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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
KEVIN M ELLIOTT DMD (PARTNER)
(208) 382-3558
Entity
Organization
Contact information
Practice address
220 SOUTH MAIN STREET, CASCADE, ID 83611
(208) 382-3558
(208) 382-3668
Mailing address
PO BOX 498, CASCADE, ID 83611-0498
(208) 382-3558
(208) 382-3668
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3280
ID
1223G0001X
General Practice Dentistry
D3826
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010155075
DR NEWTON REGENCE BS
ID
01
—
000010156002
DR ELLIOTT REGENCE BS
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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