Provider Demographics
NPI:1932732856
Name:ELITE ORTHODONTICS
Entity Type:Organization
Organization Name:ELITE ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MAHER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-706-8339
Mailing Address - Street 1:61 BERDAN AVE
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3231
Mailing Address - Country:US
Mailing Address - Phone:973-706-8339
Mailing Address - Fax:
Practice Address - Street 1:61 BERDAN AVE
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3231
Practice Address - Country:US
Practice Address - Phone:973-706-8339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-19
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty