Provider Demographics
NPI:1578747754
Name:EAST COUNTY ENDODONTICS
Entity Type:Organization
Organization Name:EAST COUNTY ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-579-0316
Mailing Address - Street 1:506 S MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6011
Mailing Address - Country:US
Mailing Address - Phone:619-579-0316
Mailing Address - Fax:
Practice Address - Street 1:506 S MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6011
Practice Address - Country:US
Practice Address - Phone:619-579-0316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA JOLLA DENTAL SPECIALTY GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-23
Last Update Date:2007-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty