Provider Demographics
NPI:1316203672
Name:PENNSYLVANIA ENDODONTIC SPECIALISTS, PC
Entity Type:Organization
Organization Name:PENNSYLVANIA ENDODONTIC SPECIALISTS, PC
Other - Org Name:ALAN KIRSCH, DDS , PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEENIE
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:ROGOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-674-5383
Mailing Address - Street 1:444 N YORK RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-2102
Mailing Address - Country:US
Mailing Address - Phone:215-674-5383
Mailing Address - Fax:215-672-6352
Practice Address - Street 1:444 N. YORK RD.
Practice Address - Street 2:
Practice Address - City:HATBORO
Practice Address - State:PA
Practice Address - Zip Code:18974
Practice Address - Country:US
Practice Address - Phone:215-674-5383
Practice Address - Fax:215-672-6352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-11
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS031457L1223E0200X
PADS0355961223E0200X
PADS016737L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty