NPIMap

Organization Active NPI

Elite Dental Group, LLC

  • General Practice Dentistry
  • Rockville, MD
National Provider Identifier
1346989522
Registry record updated May 14, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
Legal business name
ELITE DENTAL GROUP, LLC
Practice address
801 Pleasant Dr Ste 160
Rockville, MD 20850-5831
Phone
(240) 683-8111
NPI assigned
Jun 3, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 14, 2024

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

Authorized official

Name
Dr. Kavish A Gurjar, DDSNPI 1225445182
Title
Owner
Phone
(818) 746-5914

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 122300000X
General Practice DentistryGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 1223G0001X Primary

Addresses

Primary practice location

801 Pleasant Dr Ste 160
Rockville, MD 20850-5831

Mailing address

16337 Columbus Ave
Rockville, MD 20855-2194
Phone (818) 746-5914

Other names 1

  • State of the Art Dental Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230413001173 MD DME Supplier - Oral Surgery - Dentist 8224403837 Practice locations: Rockville, MD

National Provider Directory

National Provider Directory

Locations

801 Pleasant Dr
Ste 160
Rockville, MD 20850
Phone (240) 683-8111

800 Pleasant Dr
Ste 160
Rockville, MD 20850

Practitioners & affiliated clinicians

Practitioners 4

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": "1654214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715644800000",
    "number": "1346989522",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16337 COLUMBUS AVE",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208552194",
            "telephone_number": "818-746-5914"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 PLEASANT DR STE 160",
            "city": "ROCKVILLE",
            "state": "MD",
            "postal_code": "208505831",
            "telephone_number": "240-683-8111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-03",
        "last_updated": "2024-05-14",
        "certification_date": "2024-05-14",
        "status": "A",
        "authorized_official_last_name": "GURJAR",
        "authorized_official_first_name": "KAVISH",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-746-5914",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "State of the Art Dental Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "State of the Art Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rockville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.