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General NPI Number Information
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NPI Number | 1447803382
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Entity Type | Organization
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Legal Business Name | JJ ELEVATION, PLLC
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Dates
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Enumeration Date | 07/19/2019
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Last Update Date | 11/17/2023
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Provider Practice Location Address
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Address Line | 10012 COYOTE SONG TER
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-4504
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Country | US
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Telephone | 719-357-1336
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Fax |
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Provider Business Mailing Address
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Address Line | 10012 COYOTE SONG TER
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City | COLORADO SPRINGS
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State | CO
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Zip | 80924-4504
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Country | US
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Telephone | 719-357-1336
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. ADAM JOHN MCKISSOCK
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Credential | DMD
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Telephone | 719-357-1336
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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