Provider Demographics
NPI:1396862645
Name:ELKINS, EDWARD BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:BRYAN
Last Name:ELKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 516
Mailing Address - Street 2:
Mailing Address - City:COWAN
Mailing Address - State:TN
Mailing Address - Zip Code:37318-0516
Mailing Address - Country:US
Mailing Address - Phone:931-967-7092
Mailing Address - Fax:931-967-7303
Practice Address - Street 1:109 FRONT ST S
Practice Address - Street 2:
Practice Address - City:COWAN
Practice Address - State:TN
Practice Address - Zip Code:37318-3311
Practice Address - Country:US
Practice Address - Phone:931-967-7092
Practice Address - Fax:931-967-7303
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0068681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice