Provider Demographics
NPI:1518906965
Name:EAST SIDE ENDODONTICS
Entity Type:Organization
Organization Name:EAST SIDE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:S
Authorized Official - Last Name:TANZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-521-3746
Mailing Address - Street 1:130 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2010
Mailing Address - Country:US
Mailing Address - Phone:401-521-3746
Mailing Address - Fax:401-521-0037
Practice Address - Street 1:130 WATERMAN ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2010
Practice Address - Country:US
Practice Address - Phone:401-521-3746
Practice Address - Fax:401-521-0037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI21731223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty