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General NPI Number Information
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NPI Number | 1770860728
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Entity Type | Organization
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Legal Business Name | ENDODONTIC ASSOCIATES
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 11/04/2011
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Provider Practice Location Address
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Address Line | 1375 CHERRY WAY DR SUITE 200
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City | GAHANNA
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State | OH
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Zip | 43230-8700
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Country | US
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Telephone | 614-428-7320
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Fax |
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Provider Business Mailing Address
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Address Line | 1375 CHERRY WAY DR SUITE 200
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City | GAHANNA
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State | OH
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Zip | 43230-8700
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Country | US
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Telephone | 614-428-7320
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JUDY JOSE
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Credential |
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Telephone | 614-428-7320
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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 | 30020138
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License Number State | OH
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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 | 30019954
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License Number State |
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