Provider Demographics
NPI:1003186628
Name:ADVANCED UPSTSTE ENDODONTICS
Entity Type:Organization
Organization Name:ADVANCED UPSTSTE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:PFISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:862-624-9229
Mailing Address - Street 1:PO BOX 1936
Mailing Address - Street 2:
Mailing Address - City:CLEMSON
Mailing Address - State:SC
Mailing Address - Zip Code:29633-1936
Mailing Address - Country:US
Mailing Address - Phone:864-624-9229
Mailing Address - Fax:864-624-9595
Practice Address - Street 1:101 FINLEY ST
Practice Address - Street 2:
Practice Address - City:CLEMSON
Practice Address - State:SC
Practice Address - Zip Code:29631-1583
Practice Address - Country:US
Practice Address - Phone:864-624-9229
Practice Address - Fax:864-624-9595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC766 ENDO1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty