Provider Demographics
NPI:1184900797
Name:NEUMAN, ELLIOT DOUGLAS (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:DOUGLAS
Last Name:NEUMAN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 E MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40508-2328
Mailing Address - Country:US
Mailing Address - Phone:859-252-7726
Mailing Address - Fax:859-252-7728
Practice Address - Street 1:540 E MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40508-2328
Practice Address - Country:US
Practice Address - Phone:859-252-7726
Practice Address - Fax:859-252-7728
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9561223P0300X
KY9025122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist