Provider Demographics
NPI:1235638347
Name:ESSEX ENDODONTICS PC
Entity Type:Organization
Organization Name:ESSEX ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUDHARANI
Authorized Official - Middle Name:
Authorized Official - Last Name:BODEPUDI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-762-3214
Mailing Address - Street 1:460 BLOOMFIELD AVE STE 311
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3552
Mailing Address - Country:US
Mailing Address - Phone:973-783-3535
Mailing Address - Fax:
Practice Address - Street 1:460 BLOOMFIELD AVE STE 311
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3552
Practice Address - Country:US
Practice Address - Phone:973-783-3535
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-04
Last Update Date:2018-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty