Provider Demographics
NPI:1023246592
Name:ELROD, DAVID A
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:ELROD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:MN
Mailing Address - Zip Code:55912-2507
Mailing Address - Country:US
Mailing Address - Phone:507-437-8208
Mailing Address - Fax:507-433-7348
Practice Address - Street 1:800 1ST AVE SW
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:MN
Practice Address - Zip Code:55912-2507
Practice Address - Country:US
Practice Address - Phone:507-437-8208
Practice Address - Fax:507-433-7348
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND75371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice