Provider Demographics
NPI:1356600639
Name:MCELMURRY, ROGER DOUGLAS (DDS)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:DOUGLAS
Last Name:MCELMURRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:R.
Other - Middle Name:DOUGLAS
Other - Last Name:MCELMURRY DDS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:304 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:ID
Mailing Address - Zip Code:83313
Mailing Address - Country:US
Mailing Address - Phone:208-788-2006
Mailing Address - Fax:208-788-6298
Practice Address - Street 1:304 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:ID
Practice Address - Zip Code:83313
Practice Address - Country:US
Practice Address - Phone:208-788-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-08
Last Update Date:2012-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD17171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice