Provider Demographics
NPI:1467681502
Name:BROOKLINE ENDODONTIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:BROOKLINE ENDODONTIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-532-4125
Mailing Address - Street 1:6 ESSEX CENTER DRIVE
Mailing Address - Street 2:SUITE 109
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960
Mailing Address - Country:US
Mailing Address - Phone:978-532-4125
Mailing Address - Fax:978-977-3458
Practice Address - Street 1:1 BROOKLINE PLACE
Practice Address - Street 2:SUITE 505
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7233
Practice Address - Country:US
Practice Address - Phone:617-735-8500
Practice Address - Fax:617-735-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty