Provider Demographics
NPI:1487256392
Name:LC ELITE PLLC
Entity type:Organization
Organization Name:LC ELITE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OREOLUWA
Authorized Official - Middle Name:ANUOLUWAPO
Authorized Official - Last Name:ADEGUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:832-620-8516
Mailing Address - Street 1:12435 ADAMS RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-1869
Mailing Address - Country:US
Mailing Address - Phone:832-620-8516
Mailing Address - Fax:
Practice Address - Street 1:176 GULF FWY S
Practice Address - Street 2:
Practice Address - City:LEAGUE CITY
Practice Address - State:TX
Practice Address - Zip Code:77573-3792
Practice Address - Country:US
Practice Address - Phone:832-620-8516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-15
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty