Individual
DR. NEWELL TYLER ELISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1555 S LINCOLN AVE, JEROME, ID 83338-6136
(208) 644-9166
Mailing address
2264 CANDLERIDGE DR, TWIN FALLS, ID 83301-8321
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4431
ID
Other
Enumeration date
06/22/2011
Last updated
03/27/2016
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