Provider Demographics
NPI:1790980233
Name:ELTIEN, LLC
Entity Type:Organization
Organization Name:ELTIEN, LLC
Other - Org Name:LAKESIDE DENTAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IMRE
Authorized Official - Middle Name:T
Authorized Official - Last Name:GYARMATI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-524-0255
Mailing Address - Street 1:7900 E GREEN LAKE DR N STE 200
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98103-4818
Mailing Address - Country:US
Mailing Address - Phone:206-524-0255
Mailing Address - Fax:206-524-0240
Practice Address - Street 1:7900 E GREEN LAKE DR N STE 200
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-4818
Practice Address - Country:US
Practice Address - Phone:206-524-0255
Practice Address - Fax:206-524-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty