Provider Demographics
NPI:1215181755
Name:INFINITE ENDODONTICS NORTH JERSEY
Entity Type:Organization
Organization Name:INFINITE ENDODONTICS NORTH JERSEY
Other - Org Name:INFINITE ENDODONTICS NORTH JERSEY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SAINT CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-772-3989
Mailing Address - Street 1:401 COMMERCE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034
Mailing Address - Country:US
Mailing Address - Phone:215-646-6188
Mailing Address - Fax:215-646-6369
Practice Address - Street 1:1219 MAIN AVENUE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011
Practice Address - Country:US
Practice Address - Phone:973-473-0900
Practice Address - Fax:973-772-3989
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFINITE ENDODONTICS NORTH JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-11
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020716001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty