Provider Demographics
NPI:1164200549
Name:CARTERSVILLE ENDODONTICS LLC
Entity Type:Organization
Organization Name:CARTERSVILLE ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:BONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-614-1025
Mailing Address - Street 1:4 WEST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-3518
Mailing Address - Country:US
Mailing Address - Phone:470-274-2426
Mailing Address - Fax:470-729-7556
Practice Address - Street 1:4 WEST AVE STE 100
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3518
Practice Address - Country:US
Practice Address - Phone:470-274-2426
Practice Address - Fax:470-729-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty