NPIMap

Organization Active NPI

Elite Dental Group, PA

  • Prosthodontics
  • Fort Worth, TX
National Provider Identifier
1972711794
Registry record updated Aug 17, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
License
18994 Issued in TX
Legal business name
ELITE DENTAL GROUP, PA
Practice address
1501 Handley Dr
Fort Worth, TX 76112-3328
Phone
(817) 451-4141
Fax
(817) 457-4142
NPI assigned
May 18, 2007
Last updated
Aug 17, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2007

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
(817) 457-4141

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 18994 TX Primary

Addresses

Primary practice location

1501 Handley Dr
Fort Worth, TX 76112-3328

Mailing address

1501 Handley Dr
Fort Worth, TX 76112-3328
Phone (817) 451-4141

National Provider Directory

National Provider Directory

Locations

1501 Handley Dr
Fort Worth, TX 76112
Phone (817) 451-4141

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187308800000",
    "number": "1972711794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 HANDLEY DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761123328",
            "telephone_number": "817-451-4141",
            "fax_number": "817-457-4142"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 HANDLEY DR",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761123328",
            "telephone_number": "817-451-4141",
            "fax_number": "817-457-4142"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE DENTAL GROUP, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-18",
        "last_updated": "2007-08-17",
        "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": "817-457-4141"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "TX",
            "license": "18994",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Worth, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2007; 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.