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General NPI Number Information
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NPI Number | 1023799558
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Entity Type | Individual
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Provider Name | DR. EYITEMI ELETE
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Gender | Male
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Dates
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Enumeration Date | 07/27/2023
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Last Update Date | 06/09/2025
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Provider Practice Location Address
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Address Line | 2320 W LOOP 340 STE 200B
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City | WACO
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State | TX
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Zip | 76711-2454
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Country | US
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Telephone | 254-230-9597
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 W LOOP 340 STE 200B
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City | WACO
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State | TX
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Zip | 76711-2454
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Country | US
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Telephone | 213-905-5600
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 019.035381
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123199
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License Number State | GA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 41409
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License Number State | TX
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