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General NPI Number Information
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NPI Number | 1497691109
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Entity Type | Organization
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Legal Business Name | KALAMAZOO ENDODONTICS PLLC
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Dates
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Enumeration Date | 04/25/2026
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Last Update Date | 04/25/2026
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Provider Practice Location Address
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Address Line | 1040 N 10TH ST STE 230
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City | KALAMAZOO
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State | MI
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Zip | 49009-6150
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Country | US
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Telephone | 269-372-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 307 BUTTONWOOD CIR
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City | SHREVEPORT
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State | LA
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Zip | 71106-7680
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Country | US
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Telephone | 269-929-3767
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Fax |
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Authorized Official
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Title or Position | ENDODONTIST
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Name | DR. BRADLEY PHARES
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Credential | DDS, MS
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Telephone | 269-929-3767
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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 |
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License Number State |
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