Provider Demographics
NPI:1700286853
Name:ELITE DENTISTRY CENTER LLC
Entity Type:Organization
Organization Name:ELITE DENTISTRY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BOGDAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BUTRIY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:216-464-3200
Mailing Address - Street 1:24300 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5639
Mailing Address - Country:US
Mailing Address - Phone:216-464-3200
Mailing Address - Fax:216-464-3201
Practice Address - Street 1:24300 CHAGRIN BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-5639
Practice Address - Country:US
Practice Address - Phone:216-464-3200
Practice Address - Fax:216-464-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-26
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.022982261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH293757Medicaid