Provider Demographics
NPI:1609454867
Name:ELITE DENTAL CARE EADS
Entity Type:Organization
Organization Name:ELITE DENTAL CARE EADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLINT
Authorized Official - Middle Name:
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:731-855-1053
Mailing Address - Street 1:2066 US HIGHWAY 45 BYP S
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3507
Mailing Address - Country:US
Mailing Address - Phone:731-855-1053
Mailing Address - Fax:
Practice Address - Street 1:3159 HIGHWAY 64 STE 100
Practice Address - Street 2:
Practice Address - City:EADS
Practice Address - State:TN
Practice Address - Zip Code:38028-3322
Practice Address - Country:US
Practice Address - Phone:901-465-2382
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental