1366568404 NPI number — AE ASSOCIATED ENDODONTISTS, P.C

Table of content: (NPI 1366568404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366568404 NPI number — AE ASSOCIATED ENDODONTISTS, P.C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AE ASSOCIATED ENDODONTISTS, P.C
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:
1366568404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
500 CHAPMAN ST FL 1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02021-2093
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-562-0457
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 BELMONT AVE STE 316
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALA CYNWYD
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19004-1604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-477-8941
Provider Business Practice Location Address Fax Number:
215-477-8943
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SHAW
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE
Authorized Official Telephone Number:
781-562-0457

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  DS028139L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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