Provider Demographics
NPI:1831825298
Name:ELITE DENTAL CARE RIPLEY
Entity type:Organization
Organization Name:ELITE DENTAL CARE RIPLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:LANNOM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-855-1053
Mailing Address - Street 1:2066 US HIGHWAY 45 BYP S
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:TN
Mailing Address - Zip Code:38382-3507
Mailing Address - Country:US
Mailing Address - Phone:731-855-1053
Mailing Address - Fax:
Practice Address - Street 1:1800 U.S. 51 SOUTH
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:TN
Practice Address - Zip Code:38063
Practice Address - Country:US
Practice Address - Phone:731-635-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental