Provider Demographics
NPI:1114132537
Name:ENDOART,PLLC
Entity Type:Organization
Organization Name:ENDOART,PLLC
Other - Org Name:PEORIA ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:THOMPSON
Authorized Official - Last Name:SWAGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:602-297-1111
Mailing Address - Street 1:1277 E MISSOURI AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-2917
Mailing Address - Country:US
Mailing Address - Phone:602-297-1111
Mailing Address - Fax:602-297-1110
Practice Address - Street 1:1277 E MISSOURI AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-2915
Practice Address - Country:US
Practice Address - Phone:602-297-1111
Practice Address - Fax:602-297-1110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD61221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty