| A Elite Dental, Inc | |
|
3502 Excel Dr #101 Medford OR 97504-9136 | |
| (541) 690-1656 | |
| (541) 690-1658 |
| Full Name | A Elite Dental, Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 3502 Excel Dr, Medford, Oregon |
| Authorized Official Name and Position | Tae Kyung Jung (PRESIDENT) |
| Authorized Official Contact | 5416901656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| A Elite Dental, Inc 3502 Excel Dr #101 Medford OR 97504-9136 Ph: (541) 690-1656 | A Elite Dental, Inc 3502 Excel Dr #101 Medford OR 97504-9136 Ph: (541) 690-1656 |
| NPI Number | 1578003901 |
|---|---|
| Provider Enumeration Date | 03/04/2017 |
| Last Update Date | 03/04/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578003901 | NPI | - | NPPES |
| 240506 | Medicaid | OR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 1657387-9 (Oregon) | Primary |
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