Provider Demographics
NPI:1386220010
Name:ANDY ELLIOTT DMD PSC
Entity Type:Organization
Organization Name:ANDY ELLIOTT DMD PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OLIN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:II
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-285-9317
Mailing Address - Street 1:PO BOX 1381
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:KY
Mailing Address - Zip Code:41649-1381
Mailing Address - Country:US
Mailing Address - Phone:606-285-9317
Mailing Address - Fax:606-285-4842
Practice Address - Street 1:196 KY HWY 3188
Practice Address - Street 2:
Practice Address - City:LANGLEY
Practice Address - State:KY
Practice Address - Zip Code:41645
Practice Address - Country:US
Practice Address - Phone:606-285-9317
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-23
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty