Healthcare Provider Details

I. General information

NPI: 1902489016
Provider Name (Legal Business Name): ELITE DENTAL GROUP LAKEWOOD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S WADSWORTH BLVD STE 200
LAKEWOOD CO
80232-5434
US

IV. Provider business mailing address

1200 S WADSWORTH BLVD STE 200
LAKEWOOD CO
80232-5434
US

V. Phone/Fax

Practice location:
  • Phone: 303-733-7533
  • Fax:
Mailing address:
  • Phone: 303-733-7533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. KYU HYUK JUNG
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 303-733-7533