Provider Demographics
NPI:1407157225
Name:GREENVILLE ENDODONTICS, P.A.
Entity Type:Organization
Organization Name:GREENVILLE ENDODONTICS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAVITA
Authorized Official - Middle Name:
Authorized Official - Last Name:DODDAMANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:214-801-8216
Mailing Address - Street 1:107 SUNCREEK DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-3672
Mailing Address - Country:US
Mailing Address - Phone:903-454-0123
Mailing Address - Fax:
Practice Address - Street 1:4501 JOE RAMSEY BLVD E STE 210
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7836
Practice Address - Country:US
Practice Address - Phone:903-454-0123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-10
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty