Provider Demographics
NPI:1003655333
Name:ELEVATE TONGUE TIE CENTER, PLLC
Entity type:Organization
Organization Name:ELEVATE TONGUE TIE CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANELLE
Authorized Official - Middle Name:UNHAE
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-884-1870
Mailing Address - Street 1:1900 W GERMANN RD STE 3A
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85286-6838
Mailing Address - Country:US
Mailing Address - Phone:480-712-2390
Mailing Address - Fax:
Practice Address - Street 1:1900 W GERMANN RD STE 3A
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-6838
Practice Address - Country:US
Practice Address - Phone:480-712-2390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-24
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty