Provider Demographics
NPI:1629480611
Name:MIDLAND ENDODONTICS PC
Entity Type:Organization
Organization Name:MIDLAND ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SKIDMORE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:325-716-9597
Mailing Address - Street 1:3001 W ILLINOIS AVE STE 1B1
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3181
Mailing Address - Country:US
Mailing Address - Phone:432-689-2006
Mailing Address - Fax:
Practice Address - Street 1:3001 W ILLINOIS AVE STE 1B1
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3181
Practice Address - Country:US
Practice Address - Phone:432-689-2006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty