| Organization Name: | ELITE DENTAL GROUP PC |
| NPI Number: | 1043645336 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | SATHISH L GOBICHETTYPALAYAM (PRESIDENT) |
| Mailing Address: | 523 Foundry St North Easton |
| State: | MA US |
| Postal Code: | 023562736 |
| Phone Number: | 5082384265 |
| Fax Number: | 5082302451 |
| NPI Enumeration Date: | 09/05/2013 |
| NPI Last Update Date: | 09/05/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QD0000X |
| License Number: | 22099 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Dental |
| Taxonomy Definition: | |