1790424034 NPI number — ROOTS ENDODONTICS PLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790424034 NPI number — ROOTS ENDODONTICS PLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROOTS ENDODONTICS PLC
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:
1790424034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6251 GRAND RIVER RD STE 600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRIGHTON
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48114-5321
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-552-2000
Provider Business Mailing Address Fax Number:
517-552-2885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6251 GRAND RIVER RD STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRIGHTON
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48114-5321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-552-2000
Provider Business Practice Location Address Fax Number:
517-552-2885
Provider Enumeration Date:
06/03/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VORA
Authorized Official First Name:
MAYANK
Authorized Official Middle Name:
Authorized Official Title or Position:
DOCTOR/OWNER
Authorized Official Telephone Number:
517-552-2000

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: 1235161860 . This is a "TYPE 1 NPI" identifier . This identifiers is of the category "OTHER".