Provider Demographics
NPI:1699588178
Name:ELITE DENTAL MANAGEMENT INC
Entity type:Organization
Organization Name:ELITE DENTAL MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHIN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-879-1200
Mailing Address - Street 1:2100 RIVERSIDE PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5914
Mailing Address - Country:US
Mailing Address - Phone:770-822-3400
Mailing Address - Fax:
Practice Address - Street 1:2100 RIVERSIDE PKWY STE 130
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5914
Practice Address - Country:US
Practice Address - Phone:770-822-3400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-29
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental