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General NPI Number Information
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NPI Number | 1760528905
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Entity Type | Individual
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Provider Name | OLIN ANDREW ELLIOTT II DMD
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Gender | Male
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 06/02/2016
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Provider Practice Location Address
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Address Line | 196 KY HWY 3188
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City | MARTIN
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State | KY
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Zip | 41649
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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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Provider Business Mailing Address
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Address Line | PO BOX 1381 196 KY HWY 3188
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City | MARTIN
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State | KY
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Zip | 41649
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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 |
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Name |
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Credential |
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Telephone |
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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 | 5605
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5605
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License Number State | KY
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