Provider Demographics
NPI:1043944523
Name:ELITE DENTAL GROUP THORNTON, PLLC
Entity Type:Organization
Organization Name:ELITE DENTAL GROUP THORNTON, PLLC
Other - Org Name:ELITE DENTAL GROUP THORNTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYU
Authorized Official - Middle Name:HYUK
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-450-3199
Mailing Address - Street 1:10005 GRANT ST UNIT D
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2033
Mailing Address - Country:US
Mailing Address - Phone:303-733-7533
Mailing Address - Fax:
Practice Address - Street 1:10005 GRANT ST UNIT D
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2033
Practice Address - Country:US
Practice Address - Phone:303-450-3199
Practice Address - Fax:303-450-0862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-12
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental