Provider Demographics
NPI:1295848828
Name:ENDODONTICS, P.A.
Entity Type:Organization
Organization Name:ENDODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:410-931-0250
Mailing Address - Street 1:15 OLD LYME RD
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-3719
Mailing Address - Country:US
Mailing Address - Phone:410-560-0009
Mailing Address - Fax:410-931-4876
Practice Address - Street 1:6304 KENWOOD AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-2002
Practice Address - Country:US
Practice Address - Phone:410-866-7004
Practice Address - Fax:410-866-7014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty