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General NPI Number Information
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NPI Number | 1538126263
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Entity Type | Organization
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Legal Business Name | ENDODONTICS PC
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Dates
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Enumeration Date | 04/27/2006
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 22731 NEWMAN ST STE 125
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City | DEARBORN
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State | MI
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Zip | 48124
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Country | US
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Telephone | 313-565-9118
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Fax | 313-565-2672
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Provider Business Mailing Address
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Address Line | 22731 NEWMAN ST STE 125
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City | DEARBORN
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State | MI
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Zip | 48124
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Country | US
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Telephone | 313-565-9118
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Fax | 313-565-2672
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Authorized Official
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Title or Position | BOOK KEEPER
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Name | MARIA SHANK
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Credential |
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Telephone | 313-565-9118
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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 | 9563
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 9366
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License Number State | MI
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Taxonomy #3
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 10546
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License Number State | MI
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Taxonomy #4
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 14484
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License Number State | MI
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Taxonomy #5
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 16152
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License Number State | MI
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Taxonomy #6
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 13637
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License Number State | MI
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Taxonomy #7
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 18227
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License Number State | MI
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Taxonomy #8
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 17362
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License Number State | MI
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Taxonomy #9
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 8357
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License Number State | MI
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