Provider Demographics
NPI:1467583070
Name:MAIN LINE ENDODONTIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:MAIN LINE ENDODONTIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:610-525-9845
Mailing Address - Street 1:1 ALDWYN LN
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-1400
Mailing Address - Country:US
Mailing Address - Phone:610-525-9845
Mailing Address - Fax:610-525-9760
Practice Address - Street 1:1 ALDWYN LN
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-1400
Practice Address - Country:US
Practice Address - Phone:610-525-9845
Practice Address - Fax:610-525-9760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty