Provider Demographics
NPI:1023799558
Name:ELETE, EYITEMI
Entity type:Individual
Prefix:DR
First Name:EYITEMI
Middle Name:
Last Name:ELETE
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 1:2320 W LOOP 340 STE 200B
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76711-2454
Mailing Address - Country:US
Mailing Address - Phone:213-905-5600
Mailing Address - Fax:
Practice Address - Street 1:2320 W LOOP 340 STE 200B
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76711-2454
Practice Address - Country:US
Practice Address - Phone:254-230-9597
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-27
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.035381122300000X
GADN123199122300000X
TX41409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist