Provider Demographics
NPI:1457752024
Name:ELITE ADVANCED DENTISTRY, PLLC.
Entity Type:Organization
Organization Name:ELITE ADVANCED DENTISTRY, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:713-722-8120
Mailing Address - Street 1:8538 HAMMERLY BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-1468
Mailing Address - Country:US
Mailing Address - Phone:713-722-8120
Mailing Address - Fax:
Practice Address - Street 1:8538 HAMMERLY BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-1468
Practice Address - Country:US
Practice Address - Phone:713-722-8120
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELITE ADVANCED DENTISTRY, PLLC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-14
Last Update Date:2014-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty