Provider Demographics
NPI:1366500159
Name:ENDODONTICS LTD
Entity Type:Organization
Organization Name:ENDODONTICS LTD
Other - Org Name:CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:CHRISTIE
Authorized Official - Last Name:BEARD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-530-4808
Mailing Address - Street 1:148 ADDISON AVE
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2810
Mailing Address - Country:US
Mailing Address - Phone:630-530-4808
Mailing Address - Fax:
Practice Address - Street 1:148 ADDISON AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2810
Practice Address - Country:US
Practice Address - Phone:630-530-4808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty