Individual
DR. KORTH B ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
8219 NORTHVIEW ST, BOISE, ID 83704
(208) 378-9280
(208) 378-9240
Mailing address
3700 N PLAZA RD, EMMETT, ID 83617
(208) 365-2660
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D1996
ID
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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