Provider Demographics
NPI:1457360257
Name:ELIA, KRISTI MITCHELL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:MITCHELL
Last Name:ELIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N NEWTON
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:AR
Mailing Address - Zip Code:71730
Mailing Address - Country:US
Mailing Address - Phone:870-864-8900
Mailing Address - Fax:870-864-8903
Practice Address - Street 1:225 N NEWTON
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:AR
Practice Address - Zip Code:71730
Practice Address - Country:US
Practice Address - Phone:870-864-8900
Practice Address - Fax:870-864-8903
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARAR33511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
1309879OtherUNITED CONCORDIA
5W553OtherBLUE CROSS BLUE SHIELD