A ELITE DENTAL, INC (NPI# 1578003901) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578003901 |
| Entity Type | Organization |
| Organization Name | A ELITE DENTAL, INC |
| Practice Address |
3502 Excel Dr #101 Medford OR 97504-9136 |
| Practice Telephone | 5416901656 |
| Practice Fax Number | 5416901658 |
| Mailing Telephone | 5416901656 |
| Mailing Fax Number | 5416901658 |
| Enumeration Date | 2017-03-04 |
| Last Update Date | 2017-03-04 |
| Authorized Official Name | TAE KYUNG JUNG (PRESIDENT) |
| Authorized Official Telephone | 5416901656 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QD0000X |
Clinic/Center Specialization: Dental |
1657387-9 | OR | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 240506 | 05 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | A ELITE DENTAL, INC | 1234 Riverside Ave Ste #101, Medford, OR 97501 |
| Street Address |
3502 EXCEL DR #101 |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-9136 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366537078 | Tae Kyung Jung | Dentist | 3502 Excel Dr, #1, Medford, OR 97504-9136 | 2006-10-04 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 261QD0000X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Dental |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609400035 | Medford Family Dental Care | Clinic/Center | 101 Main St Ste 220, Medford, MA 02155-4530 | 2020-02-25 |
| 1689229171 | 42 North Dental Care, LLC | Clinic/Center | 23 Riverside Ave, Medford, MA 02155-4605 | 2019-08-02 |
| 1104478619 | David A Allen Dds | Clinic/Center | 1059 Royal Ave, Medford, OR 97504-6127 | 2019-07-15 |
| 1174073043 | Creekside Family Dental | Clinic/Center | 1234 N Riverside Ave, Medford, OR 97501-4619 | 2016-10-04 |
| 1487005914 | Gio Dental At Station Landing | Clinic/Center | 8 Earhart Lndg, Medford, MA 02155-4964 | 2016-06-27 |
| 1962640771 | Jacob O. Layer, Dmd, PC | Clinic/Center | 1485 E Mcandrews Rd, Medford, OR 97504-6107 | 2009-02-02 |
| 1801074000 | First Dental, PC | Clinic/Center | 366 Salem St, Medford, MA 02155-3307 | 2008-02-11 |
| 1588848055 | Southern Oregon Periodontics, PC | Clinic/Center | 1762 E Mcandrews Rd Ste B, Medford, OR 97504-5577 | 2007-12-20 |
| 1326537143 | Jacob J Foutz Dmd, LLC | Clinic/Center | 806 E Jackson St, Medford, OR 97504-6773 | 2018-05-07 |
| 1497101430 | South Jersey Dental Sleep Center LLC | Clinic/Center | 76 N Main St, Medford, NJ 08055-2720 | 2016-05-09 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.