Provider Demographics
NPI:1306828660
Name:COBB CORNER ENDODONTICS PC
Entity Type:Organization
Organization Name:COBB CORNER ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:WEINSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-575-9633
Mailing Address - Street 1:95 WASHINGTON ST
Mailing Address - Street 2:STE 482
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-4006
Mailing Address - Country:US
Mailing Address - Phone:781-575-9633
Mailing Address - Fax:781-575-0086
Practice Address - Street 1:95 WASHINGTON ST
Practice Address - Street 2:STE 482
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-4006
Practice Address - Country:US
Practice Address - Phone:781-575-9633
Practice Address - Fax:781-575-0086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20067261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental