Provider Demographics
NPI:1215199138
Name:OCALA ENDODONTICS
Entity Type:Organization
Organization Name:OCALA ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:C
Authorized Official - Last Name:NIXON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:352-273-1202
Mailing Address - Street 1:3201 SW 34TH AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-8471
Mailing Address - Country:US
Mailing Address - Phone:352-237-1202
Mailing Address - Fax:352-237-7722
Practice Address - Street 1:3201 SW 34TH AVE STE 204
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-8471
Practice Address - Country:US
Practice Address - Phone:352-237-1202
Practice Address - Fax:352-237-7722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 147691223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty