Provider Demographics
NPI:1629098488
Name:ENDODONTIC ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEPARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-875-5863
Mailing Address - Street 1:235 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7592
Mailing Address - Country:US
Mailing Address - Phone:508-875-5863
Mailing Address - Fax:508-875-1734
Practice Address - Street 1:235 WALNUT ST
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7592
Practice Address - Country:US
Practice Address - Phone:508-875-5863
Practice Address - Fax:508-875-1734
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA183241223E0200X
MA103351223E0200X
MA190141223E0200X
MA190871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty