MEDICARE: ELITE DENTAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3691	NV

General Provider Information

NPI Number	:	1649209388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE DENTAL, INC.

Provider Business Mailing Address
First Line	:	3056 LOGGIA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2559
Country	:	US
Telephone Number	:	714-653-0447
Fax Number	:

Provider Business Practice Location Address
First Line	:	3056 LOGGIA CT
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-2559
Country	:	US
Telephone Number	:	714-653-0447
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. NHAN TRONG TRUONG
Credential	:	D.D.S.
Telephone Number	:	714-653-0447

Provider Enumeration Date	:	07/03/2006
Last Update Date	:	10/14/2014

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