Provider Demographics
NPI:1811343569
Name:ELITE EXTON DENTAL
Entity type:Organization
Organization Name:ELITE EXTON DENTAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANKUR
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOVALIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-280-9899
Mailing Address - Street 1:100 CAMPBELL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2545
Mailing Address - Country:US
Mailing Address - Phone:610-280-9899
Mailing Address - Fax:610-280-3513
Practice Address - Street 1:100 CAMPBELL BLVD STE 102
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2545
Practice Address - Country:US
Practice Address - Phone:610-280-9899
Practice Address - Fax:610-280-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-12
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental