1629301007 NPI number — ELITE DP LLC

Table of content: (NPI 1629301007)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629301007 NPI number — ELITE DP LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ELITE DP LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629301007
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4323 LEMMON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75219-2706
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-522-4444
Provider Business Mailing Address Fax Number:
214-521-0590

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4323 LEMMON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-2706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-522-4444
Provider Business Practice Location Address Fax Number:
214-521-0590
Provider Enumeration Date:
09/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MONEYMAKER
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
214-522-4444

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  14379 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1720146129 . This is a "DENTIST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com