Provider Demographics
NPI:1235790155
Name:MASON CITY ENDODONTICS LLP
Entity Type:Organization
Organization Name:MASON CITY ENDODONTICS LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARENA
Authorized Official - Middle Name:
Authorized Official - Last Name:GELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:641-530-2657
Mailing Address - Street 1:266 TRILLIUM ST NW
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-7205
Mailing Address - Country:US
Mailing Address - Phone:704-644-9444
Mailing Address - Fax:704-787-8587
Practice Address - Street 1:1530 S MONROE AVE
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-5606
Practice Address - Country:US
Practice Address - Phone:641-530-2657
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-21
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205990355OtherPROVIDER INFORMATION