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General NPI Number Information
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NPI Number | 1316222961
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Entity Type | Organization
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Legal Business Name | ENDODONTIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 10/14/2011
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Last Update Date | 10/14/2011
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Provider Practice Location Address
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Address Line | 1431 US HIGHWAY 61 SOUTH
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City | FESTUS
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State | MO
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Zip | 63028
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Country | US
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Telephone | 636-933-7001
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Fax | 636-933-7002
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Provider Business Mailing Address
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Address Line | 1431 US HIGHWAY 61 SOUTH
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City | FESTUS
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State | MO
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Zip | 63028
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Country | US
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Telephone | 636-933-7001
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Fax | 636-933-7002
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Authorized Official
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Title or Position | MEMBER
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Name | DR. COLIN HILL ELIOT
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Credential | DDS, MS
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Telephone | 636-933-7001
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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 | 2007019466
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License Number State | MO
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