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General NPI Number Information
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NPI Number | 1740215870
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Entity Type | Organization
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Legal Business Name | ELISON ORTHODONTICS PLLC
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3357 MERLIN DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7405
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Country | US
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Telephone | 208-522-9600
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Fax | 208-522-9799
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Provider Business Mailing Address
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Address Line | 3357 MERLIN DR
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City | IDAHO FALLS
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State | ID
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Zip | 83404-7405
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Country | US
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Telephone | 208-522-9600
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Fax | 208-522-9799
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Authorized Official
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Title or Position | ORTHODONTIST
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Name | DR. JOSEPH H. ELISON
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Credential | D.D.S.,M.S.
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Telephone | 208-522-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | D1702 OR
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License Number State | ID
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