Provider Demographics
NPI:1053635243
Name:ELITE DENTAL CARE
Entity Type:Organization
Organization Name:ELITE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-855-1053
Mailing Address - Street 1:2066 US HIGHWAY 45 BYP S
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3507
Mailing Address - Country:US
Mailing Address - Phone:731-855-1053
Mailing Address - Fax:731-855-8064
Practice Address - Street 1:2066 US HIGHWAY 45 BYP S
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:TN
Practice Address - Zip Code:38382-3507
Practice Address - Country:US
Practice Address - Phone:731-855-1053
Practice Address - Fax:731-855-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty