MEDICARE: ENDODONTIC ASSOCIATES OF THE PALM BEACHES, P.A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	13846	FL

General Provider Information

NPI Number	:	1083629141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDODONTIC ASSOCIATES OF THE PALM BEACHES, P.A

Provider Business Mailing Address
First Line	:	1501 PRESIDENTIAL WAY STE 7
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-1852
Country	:	US
Telephone Number	:	561-684-1312
Fax Number	:	561-684-0182

Provider Business Practice Location Address
First Line	:	1501 PRESIDENTIAL WAY STE 7
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-1852
Country	:	US
Telephone Number	:	561-684-1312
Fax Number	:	561-684-0182

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RORY E. MORTMAN
Credential	:	D.D.S
Telephone Number	:	561-684-1312

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	08/22/2020

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