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Organization

ELITE DENTAL GROUP, PA

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JENNIE HA LUONG (REGIONAL MANAGER)
(817) 457-4141
Entity
Organization

Contact information

Practice address
1501 HANDLEY DR, FORT WORTH, TX 76112-3328
(817) 451-4141
(817) 457-4142
Mailing address
1501 HANDLEY DR, FORT WORTH, TX 76112-3328
(817) 451-4141
(817) 457-4142

Taxonomy

Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
Primary
18994
TX

Other

Enumeration date
05/18/2007
Last updated
08/17/2007
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