Provider Demographics
NPI:1093384752
Name:CUSTER ENDODONTIC GROUP PLLC
Entity Type:Organization
Organization Name:CUSTER ENDODONTIC GROUP PLLC
Other - Org Name:TEXAS ENDODONTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-330-5878
Mailing Address - Street 1:5000 LEGACY DR STE 240
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-3112
Mailing Address - Country:US
Mailing Address - Phone:972-330-5878
Mailing Address - Fax:972-370-3556
Practice Address - Street 1:107 SUNCREEK DR STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-3672
Practice Address - Country:US
Practice Address - Phone:972-330-5878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-17
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty