MEDICARE: ELITE DENTAL CARE PLLC

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	2901017893	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689811788
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELITE DENTAL CARE PLLC

Provider Business Mailing Address
First Line	:	5651 W MAPLE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3791
Country	:	US
Telephone Number	:	248-851-6166
Fax Number	:	248-851-0012

Provider Business Practice Location Address
First Line	:	6765 ORCHARD LAKE RD
Second Line	:
City	:	WEST BLOOMFIELD
State	:	MI
Zip	:	48322-3422
Country	:	US
Telephone Number	:	248-851-6166
Fax Number	:	248-851-0012

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEENA M BAHU
Credential	:	D.D.S
Telephone Number	:	248-318-7614

Provider Enumeration Date	:	01/12/2009
Last Update Date	:	08/30/2024

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