Provider Demographics
NPI:1609970904
Name:ENDODONTIC CARE PC
Entity Type:Organization
Organization Name:ENDODONTIC CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:EICHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-329-5930
Mailing Address - Street 1:5 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026
Mailing Address - Country:US
Mailing Address - Phone:781-329-5930
Mailing Address - Fax:781-407-9454
Practice Address - Street 1:761 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062
Practice Address - Country:US
Practice Address - Phone:781-762-8855
Practice Address - Fax:781-769-5969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1124801223E0200X
MA1131091223E0200X
MA197401223E0200X
MA202391223E0200X
MA201291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty