Provider Demographics
NPI:1609028414
Name:INFINITE ENDODONTICS PENNSYLVANIA P C
Entity Type:Organization
Organization Name:INFINITE ENDODONTICS PENNSYLVANIA P C
Other - Org Name:INFINITE ENDODONTICS PENNSLYVANIA P C
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:SAINT CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-513-7172
Mailing Address - Street 1:456 SCHOOL LN
Mailing Address - Street 2:104
Mailing Address - City:HARLEYSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19438-1715
Mailing Address - Country:US
Mailing Address - Phone:215-513-7172
Mailing Address - Fax:215-513-7192
Practice Address - Street 1:456 SCHOOL LN
Practice Address - Street 2:104
Practice Address - City:HARLEYSVILLE
Practice Address - State:PA
Practice Address - Zip Code:19438-1715
Practice Address - Country:US
Practice Address - Phone:215-513-7172
Practice Address - Fax:215-513-7192
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFINITE ENDODONTICS PENNSLYVANIA P C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-13
Last Update Date:2008-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030449L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty