Provider Demographics
NPI:1265507164
Name:ENDODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:DIETZ
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-647-7930
Mailing Address - Street 1:43114 DEQUINDRE
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48314
Mailing Address - Country:US
Mailing Address - Phone:586-254-1110
Mailing Address - Fax:586-254-1169
Practice Address - Street 1:43114 DEQUINDRE
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48314
Practice Address - Country:US
Practice Address - Phone:586-254-1110
Practice Address - Fax:586-254-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI137331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty