Provider Demographics
NPI:1275409732
Name:ELITE DENTAL GROUP FOUNTAIN INC
Entity type:Organization
Organization Name:ELITE DENTAL GROUP FOUNTAIN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYU
Authorized Official - Middle Name:HYUK
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-278-8492
Mailing Address - Street 1:10730 E BETHANY DR STE 240
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2693
Mailing Address - Country:US
Mailing Address - Phone:720-278-8492
Mailing Address - Fax:
Practice Address - Street 1:200 PLAZA BLVD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-2504
Practice Address - Country:US
Practice Address - Phone:719-392-4201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty