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General NPI Number Information
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NPI Number | 1245877554
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Entity Type | Organization
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Legal Business Name | ELITE FAMILY DENTISTRY PLLC
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 100 POWELL DR STE 5
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City | DUNDEE
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State | MI
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Zip | 48131-8645
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Country | US
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Telephone | 517-920-4951
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Fax |
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Provider Business Mailing Address
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Address Line | 100 POWELL DR STE 5
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City | DUNDEE
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State | MI
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Zip | 48131-8645
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | RAQUEL AMADOR
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Credential |
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Telephone | 517-920-4951
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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