Provider Demographics
NPI:1033607981
Name:DMDLE,
Entity Type:Organization
Organization Name:DMDLE,
Other - Org Name:ELITE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:512-890-9900
Mailing Address - Street 1:5901 OLD FREDERICKSBURG RD STE 102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-1209
Mailing Address - Country:US
Mailing Address - Phone:512-890-9900
Mailing Address - Fax:
Practice Address - Street 1:5901 OLD FREDERICKSBURG RD STE 102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1209
Practice Address - Country:US
Practice Address - Phone:512-890-9900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-26
Last Update Date:2018-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental