Healthcare Provider Details

I. General information

NPI: 1497691109
Provider Name (Legal Business Name): KALAMAZOO ENDODONTICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2026
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 N 10TH ST STE 230
KALAMAZOO MI
49009-6150
US

IV. Provider business mailing address

307 BUTTONWOOD CIR
SHREVEPORT LA
71106-7680
US

V. Phone/Fax

Practice location:
  • Phone: 269-372-6333
  • Fax:
Mailing address:
  • Phone: 269-929-3767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. BRADLEY PHARES
Title or Position: ENDODONTIST
Credential: DDS, MS
Phone: 269-929-3767