Organization
ELITE DP LLC
Active
Other names
ELITE DENTAL
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICK MONEYMAKER (OFFICER)
(214) 522-4444
Entity
Organization
Contact information
Practice address
4323 LEMMON AVE, DALLAS, TX 75219-2706
(214) 522-4444
(214) 521-0590
Mailing address
4323 LEMMON AVE, DALLAS, TX 75219-2706
(214) 522-4444
(214) 521-0590
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
14379
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1720146129
DENTIST
TX
Enumeration date
09/16/2009
Last updated
09/16/2009
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