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General NPI Number Information
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NPI Number | 1669250361
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Entity Type | Organization
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Legal Business Name | ELKHART PEDIATRIC DENTISTRY LTD
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Dates
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Enumeration Date | 09/15/2023
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Last Update Date | 09/15/2023
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Provider Practice Location Address
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Address Line | 4420 E BRISTOL ST
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City | ELKHART
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State | IN
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Zip | 46514-6946
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Country | US
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Telephone | 574-264-9499
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2667
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City | TELLURIDE
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State | CO
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Zip | 81435-2667
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTIN MURPHY
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Credential |
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Telephone | 843-324-3410
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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