Provider Demographics
NPI:1669510566
Name:ELVIDGE & LASHEEN, DMD,PSC
Entity Type:Organization
Organization Name:ELVIDGE & LASHEEN, DMD,PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:LASHEEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:859-873-5913
Mailing Address - Street 1:360 AMSDEN AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1851
Mailing Address - Country:US
Mailing Address - Phone:859-873-5913
Mailing Address - Fax:879-879-1027
Practice Address - Street 1:360 AMSDEN AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1851
Practice Address - Country:US
Practice Address - Phone:859-873-5913
Practice Address - Fax:879-879-1027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY821853OtherUNITED CONCORDIA PROVIDER