Provider Demographics
NPI:1497101240
Name:ELITE DENTAL
Entity Type:Organization
Organization Name:ELITE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEIH
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:703-577-4317
Mailing Address - Street 1:1025 N FILLMORE ST
Mailing Address - Street 2:C
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22201-6701
Mailing Address - Country:US
Mailing Address - Phone:703-243-4500
Mailing Address - Fax:703-243-4700
Practice Address - Street 1:1025 N FILLMORE ST
Practice Address - Street 2:C
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-6701
Practice Address - Country:US
Practice Address - Phone:703-243-4500
Practice Address - Fax:703-243-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014120311223G0001X
VA04014148111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty