Provider Demographics
NPI:1467600478
Name:MIDWEST ENDODONTICS LLC
Entity Type:Organization
Organization Name:MIDWEST ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:GRAFE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-476-8000
Mailing Address - Street 1:2709 WASHINGTON AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-2411
Mailing Address - Country:US
Mailing Address - Phone:812-476-8000
Mailing Address - Fax:812-471-3901
Practice Address - Street 1:2709 WASHINGTON AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-2411
Practice Address - Country:US
Practice Address - Phone:812-476-8000
Practice Address - Fax:812-471-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty