Provider Demographics
NPI:1619952215
Name:BROOKLINE ENDODONTICS, P.C.
Entity Type:Organization
Organization Name:BROOKLINE ENDODONTICS, P.C.
Other - Org Name:ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-735-8500
Mailing Address - Street 1:1 BROOKLINE PL
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7224
Mailing Address - Country:US
Mailing Address - Phone:617-735-8500
Mailing Address - Fax:617-735-1859
Practice Address - Street 1:1 BROOKLINE PL
Practice Address - Street 2:SUITE 505
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7224
Practice Address - Country:US
Practice Address - Phone:617-735-8500
Practice Address - Fax:617-735-1859
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11836OtherBC/BS PROVIDER NUMBER