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General NPI Number Information
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NPI Number | 1043371123
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Entity Type | Organization
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Legal Business Name | ENDOWIZZ, INC.
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5105 N PARK DR SUITE 1426
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-4630
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Country | US
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Telephone | 856-662-0018
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Fax | 856-662-8318
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Provider Business Mailing Address
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Address Line | 5105 N PARK DR SUITE 1426
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City | PENNSAUKEN
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State | NJ
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Zip | 08109-4630
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Country | US
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Telephone | 856-662-0018
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Fax | 856-662-8318
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Authorized Official
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Title or Position | CEO
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Name | DR. VAUGHN CLEMENS
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Credential | DDS
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Telephone | 856-662-0018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 22DI02060100
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License Number State | NJ
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