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General NPI Number Information
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NPI Number | 1477892685
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Entity Type | Organization
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Legal Business Name | ELITE DENTAL
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Dates
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Enumeration Date | 02/07/2013
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Last Update Date | 02/07/2013
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Provider Practice Location Address
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Address Line | 218 N WEST STATE RD
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City | AMERICAN FORK
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State | UT
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Zip | 84003-1419
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Country | US
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Telephone | 801-763-7737
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Fax | 801-763-7757
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Provider Business Mailing Address
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Address Line | 218 N WEST STATE RD
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City | AMERICAN FORK
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State | UT
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Zip | 84003-1419
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Country | US
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Telephone | 801-763-7737
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Fax | 801-763-7757
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEVEN BRAITHWAITE
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Credential | D.D.S.
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Telephone | 801-763-7737
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5148371-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5070492-9922
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License Number State | UT
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