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General NPI Number Information
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NPI Number | 1366568404
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Entity Type | Organization
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Legal Business Name | AE ASSOCIATED ENDODONTISTS, P.C
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1 BELMONT AVE STE 316
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City | BALA CYNWYD
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State | PA
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Zip | 19004-1604
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Country | US
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Telephone | 215-477-8941
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Fax | 215-477-8943
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Provider Business Mailing Address
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Address Line | 500 CHAPMAN ST FL 1
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City | CANTON
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State | MA
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Zip | 02021-2093
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Country | US
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Telephone | 781-562-0457
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE
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Name | CHRISTINE SHAW
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Credential |
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Telephone | 781-562-0457
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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 | DS028139L
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License Number State | PA
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