Provider Demographics
NPI:1497810790
Name:ESCONDIDO ENDODONTICS INC
Entity Type:Organization
Organization Name:ESCONDIDO ENDODONTICS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HANLON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:760-739-1400
Mailing Address - Street 1:488 EAST VALLEY PARKWAY
Mailing Address - Street 2:SUITE 307
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3373
Mailing Address - Country:US
Mailing Address - Phone:760-739-1400
Mailing Address - Fax:760-739-1100
Practice Address - Street 1:488 EAST VALLEY PARKWAY
Practice Address - Street 2:SUITE 307
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3373
Practice Address - Country:US
Practice Address - Phone:760-739-1400
Practice Address - Fax:760-739-1100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434441223E0200X
CA372371223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty