Provider Demographics
NPI:1457720864
Name:ELEVATE DENTAL WELLNESS, PC
Entity type:Organization
Organization Name:ELEVATE DENTAL WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEINBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-279-5647
Mailing Address - Street 1:711 E VALLEY RD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8370
Mailing Address - Country:US
Mailing Address - Phone:970-279-5647
Mailing Address - Fax:
Practice Address - Street 1:711 E VALLEY RD
Practice Address - Street 2:SUITE 201A
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8370
Practice Address - Country:US
Practice Address - Phone:970-279-5647
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-16
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO93191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty