Provider Demographics
NPI:1073394581
Name:ELEVATE DENTAL CARE PLLC
Entity Type:Organization
Organization Name:ELEVATE DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:FEASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-965-3321
Mailing Address - Street 1:4701 N GALLOWAY AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-7533
Mailing Address - Country:US
Mailing Address - Phone:214-269-5458
Mailing Address - Fax:
Practice Address - Street 1:4701 N GALLOWAY AVE STE 110
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-7533
Practice Address - Country:US
Practice Address - Phone:214-269-5458
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-10
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty