Provider Demographics
NPI:1063867000
Name:CAMBRIDGE ENDODONTIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:CAMBRIDGE ENDODONTIC ASSOCIATES, PC
Other - Org Name:CAMBRIDGE ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-492-3616
Mailing Address - Street 1:1692 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1878
Mailing Address - Country:US
Mailing Address - Phone:617-492-3616
Mailing Address - Fax:617-492-8415
Practice Address - Street 1:1692 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1878
Practice Address - Country:US
Practice Address - Phone:617-492-3616
Practice Address - Fax:617-492-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-27
Last Update Date:2016-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty