Provider Demographics
NPI:1417002452
Name:ENDODONTIC ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TO BOARD
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:ENGEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-432-1600
Mailing Address - Street 1:12660 W NORTH AVE
Mailing Address - Street 2:BUILDING D
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4633
Mailing Address - Country:US
Mailing Address - Phone:262-432-1600
Mailing Address - Fax:262-432-0227
Practice Address - Street 1:12660 W NORTH AVE
Practice Address - Street 2:BUILDING D
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4633
Practice Address - Country:US
Practice Address - Phone:262-432-1600
Practice Address - Fax:262-432-0227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty