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General NPI Number Information
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NPI Number | 1184852758
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Entity Type | Organization
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Legal Business Name | KEVIN M ELLIOTT
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Dates
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Enumeration Date | 06/23/2009
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Last Update Date | 06/23/2009
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Provider Practice Location Address
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Address Line | 327 DEINHARD LN
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City | MCCALL
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State | ID
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Zip | 83638-4703
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Country | US
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Telephone | 208-634-1214
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 990
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City | MCCALL
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State | ID
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Zip | 83638-0990
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Country | US
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Telephone | 208-634-1214
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Fax |
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Authorized Official
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Title or Position | D.M.D.
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Name | DR. KEVIN MICHAEL ELLIOTT
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Credential |
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Telephone | 208-634-1214
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D3826
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License Number State | ID
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