Provider Demographics
NPI:1043371123
Name:ENDOWIZZ, INC.
Entity Type:Organization
Organization Name:ENDOWIZZ, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:856-662-0018
Mailing Address - Street 1:5105 N PARK DR
Mailing Address - Street 2:SUITE 1426
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4630
Mailing Address - Country:US
Mailing Address - Phone:856-662-0018
Mailing Address - Fax:856-662-8318
Practice Address - Street 1:5105 N PARK DR
Practice Address - Street 2:SUITE 1426
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4630
Practice Address - Country:US
Practice Address - Phone:856-662-0018
Practice Address - Fax:856-662-8318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020601001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty