Elite Dental Management Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

Legal business name

ELITE DENTAL MANAGEMENT INC

Practice address

2100 Riverside Pkwy Ste 130
Lawrenceville, GA 30043-5914

Phone

(770) 822-3400

NPI assigned

Jan 29, 2025

Organization subpart

No

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

Authorized official

Name

Dr. Chin Park, DMDNPI 1508139890

Title

Dentist/Owner

Phone

(770) 879-1200

Specialties & licenses 1

Addresses

Other names 1

• Riverside Family Dental 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.

• Chin S Park, DMD

  • General Practice Dentistry
  • Stone Mountain, GA
  • NPI 1508139890
  NPD Authorized official

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

{
    "created_epoch": "1738108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1750204800000",
    "number": "1699588178",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 RIVERSIDE PKWY STE 130",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435914",
            "telephone_number": "770-822-3400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 RIVERSIDE PKWY STE 130",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300435914",
            "telephone_number": "770-822-3400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL MANAGEMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-01-29",
        "last_updated": "2025-06-18",
        "certification_date": "2025-06-18",
        "status": "A",
        "authorized_official_last_name": "PARK",
        "authorized_official_first_name": "CHIN",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "770-879-1200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Elite Care Services LLC
• Elite Care Transit
• Elite Chiropractic and Wellness, LLC
• Elite Diagnostics Labs, Inc
• Elite Medical Laboratories Inc
• Elite Wellness Inc
• Elle'S Pharmacy
• Richard S Ellin, MD

• Dental Clinic/Center in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2025; 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.