Provider Demographics
NPI:1366560914
Name:DENTAL ELEGANCE, INC.
Entity type:Organization
Organization Name:DENTAL ELEGANCE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER-PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAT
Authorized Official - Middle Name:S
Authorized Official - Last Name:SEVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-558-7600
Mailing Address - Street 1:1425 W ELLIOT RD
Mailing Address - Street 2:STE 105
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-5129
Mailing Address - Country:US
Mailing Address - Phone:480-558-7600
Mailing Address - Fax:480-558-8006
Practice Address - Street 1:1425 W ELLIOT RD
Practice Address - Street 2:STE 105
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85233-5129
Practice Address - Country:US
Practice Address - Phone:480-558-7600
Practice Address - Fax:480-558-8006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty