Organization
KORTH B. ELLIOTT, DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KORTH B ELLIOTT DDS (OWNER)
(208) 378-9280
Entity
Organization
Contact information
Practice address
8219 NORTHVIEW ST, BOISE, ID 83704-7131
(208) 378-9280
Mailing address
8219 NORTHVIEW ST, BOISE, ID 83704-7131
(208) 378-9280
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-1996
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002652300
—
ID
Enumeration date
05/04/2008
Last updated
05/04/2008
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