Provider Demographics
NPI:1699506287
Name:ELITE DENTISTRY AND IMPLANTS, PLLC
Entity type:Organization
Organization Name:ELITE DENTISTRY AND IMPLANTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:RUSTEMIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-316-3701
Mailing Address - Street 1:138 GARLAND RD
Mailing Address - Street 2:
Mailing Address - City:LIMESTONE
Mailing Address - State:TN
Mailing Address - Zip Code:37681-2800
Mailing Address - Country:US
Mailing Address - Phone:352-316-3701
Mailing Address - Fax:
Practice Address - Street 1:1339 MORELAND DR STE 1
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37663-4307
Practice Address - Country:US
Practice Address - Phone:423-239-7450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty