Provider Demographics
NPI:1528218369
Name:NORTH RIVER ENDODONTICS, PLLC
Entity Type:Organization
Organization Name:NORTH RIVER ENDODONTICS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-876-0408
Mailing Address - Street 1:1017 EXECUTIVE DR
Mailing Address - Street 2:SUITE #102
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-7910
Mailing Address - Country:US
Mailing Address - Phone:423-876-0408
Mailing Address - Fax:423-876-0410
Practice Address - Street 1:1017 EXECUTIVE DR
Practice Address - Street 2:SUITE #102
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-7910
Practice Address - Country:US
Practice Address - Phone:423-876-0408
Practice Address - Fax:423-876-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79841223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty