Provider Demographics
NPI:1467010629
Name:ELKHORN DENTAL PSC
Entity Type:Organization
Organization Name:ELKHORN DENTAL PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:D
Authorized Official - Last Name:JUSTICE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-754-0155
Mailing Address - Street 1:PO BOX 1500
Mailing Address - Street 2:
Mailing Address - City:ELKHORN CITY
Mailing Address - State:KY
Mailing Address - Zip Code:41522-1500
Mailing Address - Country:US
Mailing Address - Phone:606-754-0155
Mailing Address - Fax:606-754-0151
Practice Address - Street 1:155 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ELKHORN CITY
Practice Address - State:KY
Practice Address - Zip Code:41522-9043
Practice Address - Country:US
Practice Address - Phone:606-754-0155
Practice Address - Fax:606-754-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-03
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental