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General NPI Number Information
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NPI Number | 1922547728
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Entity Type | Organization
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Legal Business Name | ELITE DENTAL & AESTHETICS
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Dates
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Enumeration Date | 02/14/2017
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Last Update Date | 02/14/2017
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Provider Practice Location Address
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Address Line | 131 NW 100TH AVE
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City | PLANTATION
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State | FL
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Zip | 33324-7034
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Country | US
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Telephone | 954-476-4537
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Fax |
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Provider Business Mailing Address
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Address Line | 131 NW 100TH AVE
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City | PLANTATION
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State | FL
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Zip | 33324-7034
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Country | US
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Telephone | 954-476-4537
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | ELIZABETH KOSSAK
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Credential | DDS
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Telephone | 313-580-3258
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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 | DN21325
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License Number State | FL
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