1922452804 NPI number — ENDODONTICS AND IMPLANT ASSOCIATES,PLLC

Table of content: (NPI 1922452804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922452804 NPI number — ENDODONTICS AND IMPLANT ASSOCIATES,PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENDODONTICS AND IMPLANT ASSOCIATES,PLLC
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:
6
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:
1922452804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1621 MIDTOWN PLACE
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
MIDWEST CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-982-2121
Provider Business Mailing Address Fax Number:
405-561-0120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1621 MIDTOWN PLACE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
MIDWEST CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-982-2121
Provider Business Practice Location Address Fax Number:
405-561-0120
Provider Enumeration Date:
04/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
XU
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER MANAGER
Authorized Official Telephone Number:
646-662-3105

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  72 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com