Provider Demographics
NPI:1174005664
Name:PAINLESS ROOT CANAL SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:PAINLESS ROOT CANAL SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAGGARLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-260-3221
Mailing Address - Street 1:1647 BENNING ROAD NE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002
Mailing Address - Country:US
Mailing Address - Phone:202-864-6449
Mailing Address - Fax:
Practice Address - Street 1:1647 BENNING ROAD NE
Practice Address - Street 2:SUITE 206
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-629-1709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-31
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC252015000Medicaid