Organization
A ELITE DENTAL, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAE KYUNG JUNG DMD (PRESIDENT)
(541) 690-1656
Entity
Organization
Contact information
Practice address
3502 EXCEL DR, #101, MEDFORD, OR 97504-9136
(541) 690-1656
(541) 690-1658
Mailing address
3502 EXCEL DR, #101, MEDFORD, OR 97504-9136
(541) 690-1656
(541) 690-1658
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
1657387-9
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
240506
—
OR
Enumeration date
03/04/2017
Last updated
03/04/2017
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