Provider Demographics
NPI:1043088727
Name:ELITE FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:ELITE FAMILY DENTISTRY PLLC
Other - Org Name:ADVANCED DENTISTRY OF EL PASO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:VERASTEGUI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-234-7344
Mailing Address - Street 1:13721 ECCLES RD
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5996
Mailing Address - Country:US
Mailing Address - Phone:915-234-7344
Mailing Address - Fax:
Practice Address - Street 1:12261 EASTLAKE BLVD
Practice Address - Street 2:STE E507 & E508
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79928
Practice Address - Country:US
Practice Address - Phone:915-234-7344
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty