Provider Demographics
NPI:1629301007
Name:ELITE DP LLC
Entity Type:Organization
Organization Name:ELITE DP LLC
Other - Org Name:ELITE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:
Authorized Official - Last Name:MONEYMAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-522-4444
Mailing Address - Street 1:4323 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2706
Mailing Address - Country:US
Mailing Address - Phone:214-522-4444
Mailing Address - Fax:214-521-0590
Practice Address - Street 1:4323 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2706
Practice Address - Country:US
Practice Address - Phone:214-522-4444
Practice Address - Fax:214-521-0590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-16
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14379261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1720146129OtherDENTIST