Provider Demographics
NPI:1568504017
Name:ELKIN, PAUL MICHAEL (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:ELKIN
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 1:650 N CARRIAGE PKWY
Mailing Address - Street 2:#60
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-4507
Mailing Address - Country:US
Mailing Address - Phone:316-686-2721
Mailing Address - Fax:316-686-2744
Practice Address - Street 1:650 N CARRIAGE PKWY
Practice Address - Street 2:#60
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-4507
Practice Address - Country:US
Practice Address - Phone:316-686-2721
Practice Address - Fax:316-686-2744
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY500458411223P0221X
KS611141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201117620CMedicaid
KS003289976OtherUNITED CONCORDIA