Provider Demographics
NPI:1275752529
Name:ENDODONTIC ASSOCIATES OF CENTRAL FL,, PA
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF CENTRAL FL,, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:352-351-5588
Mailing Address - Street 1:2701 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-4471
Mailing Address - Country:US
Mailing Address - Phone:352-351-5588
Mailing Address - Fax:
Practice Address - Street 1:2701 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4471
Practice Address - Country:US
Practice Address - Phone:352-351-5588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty