Healthcare Provider Details

I. General information

NPI: 1598481871
Provider Name (Legal Business Name): ELITE DENTAL GROUP WESTMINSTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2022
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5068 W 92ND AVE
WESTMINSTER CO
80031-6302
US

IV. Provider business mailing address

5068 W 92ND AVE
WESTMINSTER CO
80031-6302
US

V. Phone/Fax

Practice location:
  • Phone: 303-426-0023
  • Fax:
Mailing address:
  • Phone: 303-426-0023
  • 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: MS. BO NAM
Title or Position: ADMINISTRATIVE DIRECTOR
Credential:
Phone: 720-278-8492