Elite Dental Associates, PA

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

18994 Issued in TX

Legal business name

ELITE DENTAL ASSOCIATES, PA

Practice address

3023 E Interstate 30
Suite H
Rockwall, TX 75087-9707

Phone

(214) 771-3130

Fax

(972) 722-0056

NPI assigned

May 18, 2007

Organization subpart

No

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

Authorized official

Name

Jennie Ha Luong

Title

Regional Manager

Phone

(214) 909-3764

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609084425",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3023 E INTERSTATE 30",
            "address_2": "SUITE H",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750879707",
            "telephone_number": "214-771-3130",
            "fax_number": "972-722-0056"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3023 E INTERSTATE 30",
            "address_2": "SUITE H",
            "city": "ROCKWALL",
            "state": "TX",
            "postal_code": "750879707",
            "telephone_number": "214-771-3130",
            "fax_number": "972-722-0056"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL ASSOCIATES, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LUONG",
        "authorized_official_first_name": "JENNIE",
        "authorized_official_middle_name": "HA",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "214-909-3764"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Prosthodontics",
            "state": "TX",
            "license": "18994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Prosthodontics in Rockwall, TX
• Providers in Rockwall, TX by specialty
• Prosthodontics in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 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.