Provider Demographics
NPI:1508473265
Name:UPSTATE ENDODONTICS, INC.
Entity Type:Organization
Organization Name:UPSTATE ENDODONTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALLACE
Authorized Official - Middle Name:LYNDON
Authorized Official - Last Name:GUILFORD
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:864-699-9931
Mailing Address - Street 1:263 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29303-2271
Mailing Address - Country:US
Mailing Address - Phone:864-699-9931
Mailing Address - Fax:864-432-2229
Practice Address - Street 1:263 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29303-2271
Practice Address - Country:US
Practice Address - Phone:864-699-9931
Practice Address - Fax:864-432-2229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty