Provider Demographics
NPI:1063282036
Name:ELEVATE DENTAL PARTNERS
Entity type:Organization
Organization Name:ELEVATE DENTAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:TREVER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-575-4225
Mailing Address - Street 1:219 E 12300 S STE I5
Mailing Address - Street 2:
Mailing Address - City:DRAPER
Mailing Address - State:UT
Mailing Address - Zip Code:84020-6970
Mailing Address - Country:US
Mailing Address - Phone:801-495-4440
Mailing Address - Fax:
Practice Address - Street 1:219 E 12300 S STE I5
Practice Address - Street 2:
Practice Address - City:DRAPER
Practice Address - State:UT
Practice Address - Zip Code:84020-6970
Practice Address - Country:US
Practice Address - Phone:801-495-4440
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-02
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty