Provider Demographics
NPI:1629809793
Name:ELITE ENDODONTICS
Entity type:Organization
Organization Name:ELITE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:845-750-5649
Mailing Address - Street 1:1500 HORIZON DR STE 112
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3966
Mailing Address - Country:US
Mailing Address - Phone:215-997-9888
Mailing Address - Fax:215-997-9890
Practice Address - Street 1:1500 HORIZON DR STE 112
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3966
Practice Address - Country:US
Practice Address - Phone:845-750-5649
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty