# CORNERSTONE FAMILY & COSMETIC DENTISTRY

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

## Provider details

- **NPI number:** 1962629527
- **Authorized official:** KEVIN M ELLIOTT DMD (PARTNER)
- **Authorized official phone:** (208) 382-3558

## Contact information

- **Practice address:** 220 SOUTH MAIN STREET, CASCADE, ID 83611
- **Practice address phone:** (208) 382-3558
- **Practice address fax:** (208) 382-3668
- **Mailing address:** PO BOX 498, CASCADE, ID 83611-0498
- **Mailing address phone:** (208) 382-3558
- **Mailing address fax:** (208) 382-3668

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D3280 | ID | Yes |
| 1223G0001X | General Practice Dentistry | D3826 | OH | — |

## 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 | — | 000010156002 | DR ELLIOTT REGENCE BS | ID |
| 01 | — | 6P003 | DR NEWTON BC BS | ID |
| 01 | — | 6P005 | DR. ELLIOTT BC BS | ID |