Provider Demographics
NPI:1306612684
Name:ELITE DENTAL GROUP CENTENNIAL INC
Entity type:Organization
Organization Name:ELITE DENTAL GROUP CENTENNIAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KYU
Authorized Official - Middle Name:HYUK
Authorized Official - Last Name:JUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-738-3888
Mailing Address - Street 1:8120 S HOLLY ST STE 210
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-4007
Mailing Address - Country:US
Mailing Address - Phone:303-738-3888
Mailing Address - Fax:
Practice Address - Street 1:8120 S HOLLY ST STE 210
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-4007
Practice Address - Country:US
Practice Address - Phone:303-738-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-28
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental