Healthcare Provider Details

I. General information

NPI: 1205335346
Provider Name (Legal Business Name): ELEVATION DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2018
Last Update Date: 09/16/2025
Certification Date: 09/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2039 US HIGHWAY 641 N
MURRAY KY
42071-7870
US

IV. Provider business mailing address

2039 US HIGHWAY 641 N
MURRAY KY
42071-7870
US

V. Phone/Fax

Practice location:
  • Phone: 270-753-9479
  • Fax: 270-761-2528
Mailing address:
  • Phone: 270-753-9479
  • Fax: 270-761-2528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9592
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. ZAKARI MILLER TAYLOR
Title or Position: OWNER/DENTIST
Credential:
Phone: 270-753-9479