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General NPI Number Information
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NPI Number | 1750085288
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Entity Type | Organization
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Legal Business Name | MA ENDODONTICS INC A DENTAL PRACTICE
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Dates
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Enumeration Date | 03/28/2023
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Last Update Date | 03/28/2023
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Provider Practice Location Address
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Address Line | 1295 E DUNNE AVE STE 210
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City | MORGAN HILL
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State | CA
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Zip | 95037-7068
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Country | US
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Telephone | 408-646-0220
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Fax |
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Provider Business Mailing Address
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Address Line | 1214 MIRABEAU LN
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City | SAN JOSE
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State | CA
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Zip | 95132-2885
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Country | US
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Telephone | 408-646-0220
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | HENRY MA
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Credential | DMD
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Telephone | 408-646-0220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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