Individual
ELLIOT VINCENT HUMISTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1337 N TAYLOR DR, SHEBOYGAN, WI 53081-3012
(920) 452-4688
Mailing address
1337 N TAYLOR DR, SHEBOYGAN, WI 53081-3012
(920) 452-4688
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
1002549-15
WI
Other
Enumeration date
06/14/2021
Last updated
06/14/2021
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