Provider Demographics
NPI:1902489016
Name:ELITE DENTAL GROUP LAKEWOOD INC
Entity Type:Organization
Organization Name:ELITE DENTAL GROUP LAKEWOOD INC
Other - Org Name:ELITE DENTAL LAKEWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/DENTIST
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:303-733-7533
Mailing Address - Street 1:1200 S WADSWORTH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5434
Mailing Address - Country:US
Mailing Address - Phone:303-733-7533
Mailing Address - Fax:
Practice Address - Street 1:1200 S WADSWORTH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5434
Practice Address - Country:US
Practice Address - Phone:303-733-7533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-05
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental