Provider Demographics
NPI:1326056680
Name:ENDODONTIC ASSOCIATES OF CLEAR LAKE INC
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF CLEAR LAKE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:LINDSEY
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MS
Authorized Official - Phone:281-461-6700
Mailing Address - Street 1:555 E MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-4367
Mailing Address - Country:US
Mailing Address - Phone:281-461-6700
Mailing Address - Fax:281-461-6711
Practice Address - Street 1:555 E MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4367
Practice Address - Country:US
Practice Address - Phone:281-461-6700
Practice Address - Fax:281-461-6711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty