Provider Demographics
NPI:1689811788
Name:ELITE DENTAL CARE PLLC
Entity Type:Organization
Organization Name:ELITE DENTAL CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEENA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-318-7614
Mailing Address - Street 1:7189 WOODLORE DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-1387
Mailing Address - Country:US
Mailing Address - Phone:248-318-7614
Mailing Address - Fax:248-669-4155
Practice Address - Street 1:6765 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3422
Practice Address - Country:US
Practice Address - Phone:248-851-6166
Practice Address - Fax:248-851-0012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010178931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3299927404Medicaid