Provider Demographics
NPI:1669239778
Name:ELITE DENTAL GROUP LLC
Entity type:Organization
Organization Name:ELITE DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HITESHKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:NADA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-867-8251
Mailing Address - Street 1:441 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6335
Mailing Address - Country:US
Mailing Address - Phone:610-867-8251
Mailing Address - Fax:
Practice Address - Street 1:441 E BROAD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6335
Practice Address - Country:US
Practice Address - Phone:610-867-8251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-05
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty