1821310657 NPI number — MICRO ENDODONTICS LLC

Table of content: (NPI 1821310657)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821310657 NPI number — MICRO ENDODONTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICRO ENDODONTICS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821310657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 CHESTNUT ST STE 9
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANDOVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01810-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-475-8008
Provider Business Mailing Address Fax Number:
978-475-9990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 CHESTNUT ST STE 9
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANDOVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01810-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-475-8008
Provider Business Practice Location Address Fax Number:
978-475-9990
Provider Enumeration Date:
02/21/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ABRASS
Authorized Official First Name:
LOUAY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
617-365-6091

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1427119403 . This is a "NPI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1588076269 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1497010292 . This is a "NPI" identifier . This identifiers is of the category "OTHER".