Provider Demographics
NPI:1144095381
Name:ELEVATION ENDODONTICS, PLLC
Entity type:Organization
Organization Name:ELEVATION ENDODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCKISSOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:719-488-2188
Mailing Address - Street 1:1720 JET STREAM DR STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-3938
Mailing Address - Country:US
Mailing Address - Phone:719-488-2188
Mailing Address - Fax:
Practice Address - Street 1:1720 JET STREAM DR STE 110
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-3938
Practice Address - Country:US
Practice Address - Phone:719-488-2188
Practice Address - Fax:719-488-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-17
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental