Organization
ELISON DENTAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL AARON ELISON DMD (PRESIDENT)
(208) 522-7216
Entity
Organization
Contact information
Practice address
3656 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 522-7216
Mailing address
3656 WASHINGTON PKWY, IDAHO FALLS, ID 83404-7573
(208) 522-7216
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3605
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806380000
—
ID
Enumeration date
06/03/2008
Last updated
06/03/2008
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