Provider Demographics
NPI:1649576935
Name:ELITE DENTAL PLLC
Entity Type:Organization
Organization Name:ELITE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:FRANKLIN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-397-5422
Mailing Address - Street 1:334 HIGHWAY 92 SOUTH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DANDRIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37725
Mailing Address - Country:US
Mailing Address - Phone:865-397-5422
Mailing Address - Fax:865-397-5422
Practice Address - Street 1:334 HIGHWAY 92 SOUTH
Practice Address - Street 2:SUITE 1
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725
Practice Address - Country:US
Practice Address - Phone:865-397-5422
Practice Address - Fax:865-397-5432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-03
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS8571122300000X
TNBS8609122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty