Provider Demographics
NPI:1114025236
Name:ENDODONTICS
Entity Type:Organization
Organization Name:ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DEGROOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-775-2025
Mailing Address - Street 1:609 N CHARLES RICHARD BEALL BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2218
Mailing Address - Country:US
Mailing Address - Phone:386-775-2025
Mailing Address - Fax:
Practice Address - Street 1:609 N CHARLES RICHARD BEALL BLVD STE 105
Practice Address - Street 2:
Practice Address - City:DEBARY
Practice Address - State:FL
Practice Address - Zip Code:32713-2218
Practice Address - Country:US
Practice Address - Phone:386-775-2025
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00123051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty