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General NPI Number Information
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NPI Number | 1215040738
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Entity Type | Organization
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Legal Business Name | THE ENDODONTIC GROUP, INC.
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 8201 PRESTON RD STE 375
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City | DALLAS
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State | TX
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Zip | 75225-6203
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Country | US
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Telephone | 214-361-6669
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Fax | 214-361-1847
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Provider Business Mailing Address
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Address Line | 8201 PRESTON RD STE 375
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City | DALLAS
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State | TX
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Zip | 75225-6203
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Country | US
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Telephone | 214-361-6669
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Fax | 214-361-1847
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. ELIZABETH ANN ODDSON
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Credential |
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Telephone | 214-361-6669
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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 | 10970
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License Number State | TX
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