Provider Demographics
NPI:1225102676
Name:ENDODONTIC ASSOCIATES LLC
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNAS
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:FLINT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:504-899-1416
Mailing Address - Street 1:190 CROSS GATES BLVD
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70461-4179
Mailing Address - Country:US
Mailing Address - Phone:504-899-1416
Mailing Address - Fax:
Practice Address - Street 1:190 CROSS GATES BLVD
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70461-4179
Practice Address - Country:US
Practice Address - Phone:504-899-1416
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty