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General NPI Number Information
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NPI Number | 1720640444
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Entity Type | Organization
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Legal Business Name | SPRINGFIELD ENDODONTICS, LLC
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Dates
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Enumeration Date | 07/02/2019
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Last Update Date | 07/02/2019
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Provider Practice Location Address
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Address Line | 1050 BALTIMORE PIKE
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City | SPRINGFIELD
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State | PA
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Zip | 19064-2853
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Country | US
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Telephone | 240-260-3223
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Fax |
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Provider Business Mailing Address
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Address Line | 804 PERSHING DR STE 102
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City | SILVER SPRING
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State | MD
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Zip | 20910-4436
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Country | US
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Telephone | 240-260-3223
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATIONS OFFICER
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Name | TIFINY MCDONALD
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Credential |
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Telephone | 240-260-3223
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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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