Provider Demographics
NPI:1477709640
Name:ADVANCED ENDODONTIC ASSOCIATES, PC
Entity Type:Organization
Organization Name:ADVANCED ENDODONTIC ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:G
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-531-3400
Mailing Address - Street 1:39 CROSS ST STE 304
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-1666
Mailing Address - Country:US
Mailing Address - Phone:978-531-3400
Mailing Address - Fax:978-531-3415
Practice Address - Street 1:39 CROSS ST STE 304
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1666
Practice Address - Country:US
Practice Address - Phone:978-531-3400
Practice Address - Fax:978-531-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205141223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty