Provider Demographics
NPI:1215183744
Name:ENDODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:E
Authorized Official - Last Name:MICHANOWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:412-682-2524
Mailing Address - Street 1:3516 5TH AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3332
Mailing Address - Country:US
Mailing Address - Phone:412-682-2524
Mailing Address - Fax:412-682-5238
Practice Address - Street 1:3516 5TH AVE
Practice Address - Street 2:SUITE #2
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3332
Practice Address - Country:US
Practice Address - Phone:412-682-2524
Practice Address - Fax:412-682-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS013153L1223E0200X
PADS014613L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty