# ELITE DENTAL GROUP CANON CITY INC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Elite Dental Group Canon City
- **Organization subpart:** No

## Provider details

- **NPI number:** 1518747765
- **Authorized official:** DR. KYU HYUK JUNG DDS (PRESIDENT/DENTIST)
- **Authorized official phone:** (719) 275-5933

## Contact information

- **Practice address:** 1215 N 15TH ST, CANON CITY, CO 81212-4620
- **Practice address phone:** (719) 275-5933
- **Mailing address:** 1215 N 15TH ST, CANON CITY, CO 81212-4620

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/04/2023
- **Last updated:** 11/15/2023