ELITE DENTAL GROUP, PA (NPI# 1972711794) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1972711794 |
| Entity Type | Organization |
| Organization Name | ELITE DENTAL GROUP, PA |
| Practice Address |
1501 Handley Dr Fort Worth TX 76112-3328 |
| Practice Telephone | 8174514141 |
| Practice Fax Number | 8174574142 |
| Mailing Telephone | 8174514141 |
| Mailing Fax Number | 8174574142 |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2007-08-17 |
| Authorized Official Name | JENNIE HA LUONG (REGIONAL MANAGER) |
| Authorized Official Telephone | 8174574141 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
18994 | TX | Dental Providers |
| Street Address |
1501 HANDLEY DR |
| City | FORT WORTH |
| State | TX |
| Zip Code | 76112-3328 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1033133699 | Andy Chi Chang | Dentist | 1501 Handley Dr, Fort Worth, TX 76112-3328 | 2006-07-27 |
| 1972817948 | Lacedric Reitrich Tolliver | Dentist | 1501 Handley Dr, Fort Worth, TX 76112-3328 | 2010-08-02 |
| 1548495443 | Western Dental | Dentist | 1501 Handley Dr, Fort Worth, TX 76112 | 2009-05-20 |
| 1427072099 | Brian Ashley Alford | Dentist | 1501 Handley Dr, Fort Worth, TX 76112-3328 | 2006-07-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396211397 | Shelia Minor | Home Health Aide | 5648 Victoria Place, Fort Worth, TX 76112 | 2018-10-17 |
| 1457833816 | Joanne Medford | Physical Therapy Assistant | 1704 Wilson Rd, Fort Worth, TX 76112 | 2018-09-02 |
| 1821525502 | Kids & Hugs Home Therapy | Home Health | 2317 Maryel Dr., Fort Worth, TX 76112 | 2017-05-12 |
| 1932516846 | Neuroassessment Services LLC | Clinical Neuropsychologist | 5601 Bridge Street, Suite 500, Ft. Worth, TX 76112 | 2014-07-14 |
| 1114346335 | Blessed Beginnings | Day Training, Developmentally Disabled Services | 2320 Blue Smoke Court North, Fort Worth, TX 76112 | 2014-04-15 |
| 1790035517 | Transitions for Success Inc | In Home Supportive Care | 6228 Warrington Pl Ace, Fort Worth, TX 76112 | 2012-09-19 |
| 1194048116 | Jerlene Bonner Tippett | Home Health Aide | 1701 Bunch Dr, Ft Worth, TX 76112 | 2010-03-04 |
| 1396076543 | Roy Kenji Yamada | Emergency Medicine | 5800 Forest Bend Pl., Ft. Worth, TX 76112 | 2010-01-27 |
| 1437488228 | Rose A Miller | Case Manager/Care Coordinator | 7312 Laurie Drive, Ft. Worth, TX 76112 | 2009-12-08 |
| 1174760508 | Advocate Angels | Case Management | 6829 Gary Lane, Fort Worth, TX 76112 | 2009-01-07 |
| Find all providers in zip 76112 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376953471 | Priya Vinothini Colluru | Dentist | 3913, Wheeler's Street, Fort Worth, TX 76111 | 2014-04-29 |
| 1679627590 | Carlos G. Tello Dds Ms Pa | Dentist | 5340 Davis Blvd, Fort Worth, TX 76180 | 2007-01-22 |
| 1033133699 | Andy Chi Chang | Dentist | 1501 Handley Dr, Fort Worth, TX 76112-3328 | 2006-07-27 |
| 1326585274 | Fossil Ridge Family Dentistry Pllc | Dentist | 3900 N Tarrant Pkwy Ste 100, Fort Worth, TX 76244-5410 | 2017-01-30 |
| 1356683486 | James Fischer | Dentist | 1005 5th Ave, Fort Worth, TX 76104-2937 | 2013-03-27 |
| 1619280328 | Yaser Al-yakoubi | Dentist | 6302 Meadowbrook Dr, Suite#112, Fort Worth, TX 76112-5162 | 2010-07-22 |
| 1003825100 | Michael D Cosgrove | Dentist | 1005 5th Ave, Fort Worth, TX 76104-2937 | 2006-08-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386779 | Daniela Rubiano Mejia | Dentist | 505 W Louis Henna Blvd Ste 505, Austin, TX 78728-1701 | 2020-11-05 |
| 1235738527 | Lorena Malpica | Dentist | 5602 Presidio Pkwy Apt 1411, San Antonio, TX 78249-3093 | 2020-10-19 |
| 1922606870 | Luciano Retana | Dentist | 1235 Kinwest Pkwy, Irving, TX 75063-3403 | 2020-10-13 |
| 1295332393 | Jonathan P Hawley | Dentist | 2423 Barrow St, Abilene, TX 79605-6203 | 2020-10-02 |
| 1629684402 | Ramon Noel Hernandez | Dentist | 13000 N Interstate 35 Ste 206, Austin, TX 78753-1030 | 2020-09-17 |
| 1720697600 | Silvia Sobrecueva | Dentist | 4724 Sweetwater Blvd Ste 103, Sugar Land, TX 77479-3150 | 2020-07-27 |
| 1922620400 | Luis Herra | Dentist | 3838 N Braeswood Blvd Apt 249, Houston, TX 77025-3018 | 2020-05-07 |
| 1396381398 | Sixth Dental Partner Pllc | Dentist | 6700 Stonebrook Pkwy Ste 101, Frisco, TX 75034-9639 | 2019-11-25 |
| 1902442155 | Amin Ehsan | Dentist | 106 W Gray St, Houston, Houston, TX 77019 | 2019-11-22 |
| 1629627716 | Mohammad Mehdi Imani Emadi | Dentist | 11970 N Central Expy # 430, Dallas, TX 75243 | 2019-09-10 |
| Find all providers with the same taxonomy | ||||
| City | FORT WORTH |
| Zip Code | 76112 |
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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.