Elite Dental Group Co Springs Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ELITE DENTAL GROUP CO SPRINGS INC

Doing business as

Elite Dental Group Co Springs

Practice address

1855 S Nevada Ave
Colorado Springs, CO 80905-2516

Phone

(719) 471-1717

Fax

(719) 447-0605

NPI assigned

Jan 10, 2023

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kyu Jung, DDS

Title

President/Dentist

Phone

(719) 471-1717

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elite Dental Group Co Springs Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1673308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696377600000",
    "number": "1104530542",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10700 E BETHANY DR STE 210",
            "city": "AURORA",
            "state": "CO",
            "postal_code": "800142680",
            "telephone_number": "303-745-8828",
            "fax_number": "720-748-8867"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1855 S NEVADA AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809052516",
            "telephone_number": "719-471-1717",
            "fax_number": "719-447-0605"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL GROUP CO SPRINGS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-10",
        "last_updated": "2023-10-04",
        "certification_date": "2023-10-04",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "KYU",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "719-471-1717",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396261251",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Dental Group Co Springs",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Dental Clinic/Center in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Dental Clinic/Center in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.