Healthcare Provider Details

I. General information

NPI: 1740375211
Provider Name (Legal Business Name): ENDODONTIC ASSOCIATES OF GAINESVILLE, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW 76TH DRIVE
GAINESVILLE FL
32607
US

IV. Provider business mailing address

340 NW 76TH DRIVE
GAINESVILLE FL
32607
US

V. Phone/Fax

Practice location:
  • Phone: 352-331-3113
  • Fax: 352-331-5950
Mailing address:
  • Phone: 352-331-3113
  • Fax: 352-331-5950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. KATHY Z TYLER
Title or Position: PRESIDENT
Credential: DMD
Phone: 352-331-3113