NPIMap

Organization Active NPI

Elite Dental LLC

  • General Practice Dentistry
  • Philadelphia, PA
National Provider Identifier
1124543368
Registry record updated Mar 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ELITE DENTAL LLC
Practice address
400 W Allegheny Ave Ste B-1
Philadelphia, PA 19133-3639
Phone
(215) 291-9200
NPI assigned
Aug 9, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 12, 2020

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

Authorized official

Name
Phil Kural
Title
Director Doctor Credentialing
Phone
(312) 274-4526

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

400 W Allegheny Ave Ste B-1
Philadelphia, PA 19133-3639

Mailing address

350 N Clark St Ste 600
Chicago, IL 60654-4782

National Provider Directory

National Provider Directory
Tax ID family
Elite Dental LLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

400 W Allegheny Ave
Ste B1
Philadelphia, PA 19133
Phone (215) 291-9200

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1502236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1583971200000",
    "number": "1124543368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 N CLARK ST STE 600",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606544782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 W ALLEGHENY AVE STE B-1",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191333639",
            "telephone_number": "215-291-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-09",
        "last_updated": "2020-03-12",
        "certification_date": "2020-03-12",
        "status": "A",
        "authorized_official_last_name": "KURAL",
        "authorized_official_first_name": "PHIL",
        "authorized_official_title_or_position": "DIRECTOR DOCTOR CREDENTIALING",
        "authorized_official_telephone_number": "312-274-4526"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2020; 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.