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General NPI Number Information
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NPI Number | 1386220010
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Entity Type | Organization
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Legal Business Name | ANDY ELLIOTT DMD PSC
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Dates
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Enumeration Date | 03/23/2021
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 196 KY HWY 3188
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City | LANGLEY
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State | KY
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Zip | 41645
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Country | US
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Telephone | 606-285-9317
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1381
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City | MARTIN
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State | KY
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Zip | 41649-1381
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Country | US
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Telephone | 606-285-9317
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Fax | 606-285-4842
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLIN ANDREW ELLIOTT II
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Credential | DMD
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Telephone | 606-285-9317
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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 |
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License Number State |
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