Provider Demographics
NPI:1275163099
Name:ELITE ENDODONTICS
Entity Type:Organization
Organization Name:ELITE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:850-696-0820
Mailing Address - Street 1:5016 GRANDE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-8991
Mailing Address - Country:US
Mailing Address - Phone:850-696-0820
Mailing Address - Fax:850-696-0458
Practice Address - Street 1:5016 GRANDE DR STE 101
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8991
Practice Address - Country:US
Practice Address - Phone:850-696-0820
Practice Address - Fax:850-696-0458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty