Provider Demographics
NPI:1083629141
Name:ENDODONTIC ASSOCIATES OF THE PALM BEACHES, P.A
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF THE PALM BEACHES, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MORTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:561-684-1312
Mailing Address - Street 1:1501 PRESIDENTIAL WAY STE 7
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1852
Mailing Address - Country:US
Mailing Address - Phone:561-684-1312
Mailing Address - Fax:561-684-0182
Practice Address - Street 1:1501 PRESIDENTIAL WAY STE 7
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1852
Practice Address - Country:US
Practice Address - Phone:561-684-1312
Practice Address - Fax:561-684-0182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL138461223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty