Provider Demographics
NPI:1841584737
Name:ELKINGTON, CHARLES JUSTUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:JUSTUS
Last Name:ELKINGTON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W PINE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1426
Mailing Address - Country:US
Mailing Address - Phone:573-664-1100
Mailing Address - Fax:573-664-1102
Practice Address - Street 1:508 W PINE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1426
Practice Address - Country:US
Practice Address - Phone:573-664-1100
Practice Address - Fax:573-664-1102
Is Sole Proprietor?:No
Enumeration Date:2011-06-08
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011014783122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist