MEDICARE: ENDODONTIC ASSOCIATES, P.C.

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	D6329	OR

General Provider Information

NPI Number	:	1356348379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENDODONTIC ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	700 NE MULTNOMAH ST
Second Line	:	#880
City	:	PORTLAND
State	:	OR
Zip	:	97232-2131
Country	:	US
Telephone Number	:	503-230-1234
Fax Number	:	503-239-7741

Provider Business Practice Location Address
First Line	:	700 NE MULTNOMAH ST
Second Line	:	#880
City	:	PORTLAND
State	:	OR
Zip	:	97232-2131
Country	:	US
Telephone Number	:	503-230-1234
Fax Number	:	503-239-7741

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL M. MADDEN
Credential	:	D.M.D.
Telephone Number	:	503-230-1234

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	08/22/2020

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