Elite Dental Group Canon City Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ELITE DENTAL GROUP CANON CITY INC

Doing business as

Elite Dental Group Canon City

Practice address

1215 N 15TH St
Canon City, CO 81212-4620

Phone

(719) 275-5933

NPI assigned

Oct 4, 2023

Last updated

Nov 15, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kyu Hyuk Jung, DDS

Title

President/Dentist

Phone

(719) 275-5933

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Elite Dental Group Canon City Doing business as

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Dean E Sandoval, D.D.S.

  • General Practice Dentistry
  • Canon City, CO
  • NPI 1255419479
  NPD (past)

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

{
    "created_epoch": "1696377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1700006400000",
    "number": "1518747765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 N 15TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124620"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 N 15TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124620",
            "telephone_number": "719-275-5933"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL GROUP CANON CITY INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-04",
        "last_updated": "2023-11-15",
        "certification_date": "2023-11-15",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "KYU",
        "authorized_official_middle_name": "HYUK",
        "authorized_official_title_or_position": "PRESIDENT/DENTIST",
        "authorized_official_telephone_number": "719-275-5933",
        "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 Canon City",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ease-E Medical Inc.
• Cresta Ebenstein, MA
• Josi L Edwards, LPN
• Dave Earl Egerdahl, R.D.
• Elevation Counseling Services Inc.
• Ellington Eyecare PLLC
• Steven Michael Ellington
• Angela Dawn Elliott, MA, CCC-SLP
• Erica K Elliott, LPC
• Karolyn G Ellis, PHYSICAL THERAPIST

• Dental Clinic/Center in Canon City, CO
• Providers in Canon City, 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 Nov 15, 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.