Provider Demographics
NPI:1912310939
Name:MCELVAIN, JUSTIN (DDS)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:MCELVAIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 STACY RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FAIRVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75069-8741
Mailing Address - Country:US
Mailing Address - Phone:214-383-2626
Mailing Address - Fax:214-383-1826
Practice Address - Street 1:431 STACY RD
Practice Address - Street 2:SUITE 108
Practice Address - City:FAIRVIEW
Practice Address - State:TX
Practice Address - Zip Code:75069-8741
Practice Address - Country:US
Practice Address - Phone:214-383-2626
Practice Address - Fax:214-383-1826
Is Sole Proprietor?:No
Enumeration Date:2014-06-06
Last Update Date:2015-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX299481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice