Provider Demographics
NPI:1568485910
Name:INNOVATIVE ENDODONTICS, P.C.
Entity Type:Organization
Organization Name:INNOVATIVE ENDODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:LAW
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-633-0097
Mailing Address - Street 1:600 VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-3535
Mailing Address - Country:US
Mailing Address - Phone:973-633-0097
Mailing Address - Fax:973-633-5029
Practice Address - Street 1:600 VALLEY RD
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-3535
Practice Address - Country:US
Practice Address - Phone:973-633-0097
Practice Address - Fax:973-633-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ176951223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty