Provider Demographics
NPI:1437481876
Name:ADVANCED ENDODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:ADVANCED ENDODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:CARDENAS
Authorized Official - Last Name:EITTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSD
Authorized Official - Phone:360-434-3636
Mailing Address - Street 1:335 E SONTERRA BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4071
Mailing Address - Country:US
Mailing Address - Phone:360-434-3636
Mailing Address - Fax:
Practice Address - Street 1:335 E SONTERRA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4071
Practice Address - Country:US
Practice Address - Phone:360-434-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-10
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6029900761223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty