Provider Demographics
NPI:1346989522
Name:ELITE DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:ELITE DENTAL GROUP, LLC
Other - Org Name:STATE OF THE ART DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVISH
Authorized Official - Middle Name:A
Authorized Official - Last Name:GURJAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-746-5914
Mailing Address - Street 1:16337 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20855-2194
Mailing Address - Country:US
Mailing Address - Phone:818-746-5914
Mailing Address - Fax:
Practice Address - Street 1:801 PLEASANT DR STE 160
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5831
Practice Address - Country:US
Practice Address - Phone:240-683-8111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-03
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty