Provider Demographics
NPI:1477892685
Name:ELITE DENTAL
Entity Type:Organization
Organization Name:ELITE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAITHWAITE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-763-7737
Mailing Address - Street 1:218 N WEST STATE RD
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1419
Mailing Address - Country:US
Mailing Address - Phone:801-763-7737
Mailing Address - Fax:801-763-7757
Practice Address - Street 1:218 N WEST STATE RD
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1419
Practice Address - Country:US
Practice Address - Phone:801-763-7737
Practice Address - Fax:801-763-7757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5148371-99221223G0001X
UT5070492-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty