Provider Demographics
NPI:1356088017
Name:PRIORITY ENDODONTICS LLC
Entity Type:Organization
Organization Name:PRIORITY ENDODONTICS LLC
Other - Org Name:PRIORITY ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RAJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:260-888-3502
Mailing Address - Street 1:5483 COVENTRY LN APT 301
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-7182
Mailing Address - Country:US
Mailing Address - Phone:213-399-0393
Mailing Address - Fax:
Practice Address - Street 1:9918 ILLINOIS RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-5770
Practice Address - Country:US
Practice Address - Phone:414-522-7325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty