Provider Demographics
NPI:1679639710
Name:ENDODONTIC ASSOCIATESLLC
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATESLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAKICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-869-8840
Mailing Address - Street 1:851 S RAMPART BLVD
Mailing Address - Street 2:SUITE # 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89145-4882
Mailing Address - Country:US
Mailing Address - Phone:702-869-8840
Mailing Address - Fax:702-240-0481
Practice Address - Street 1:851 S RAMPART BLVD
Practice Address - Street 2:SUITE # 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89145-4882
Practice Address - Country:US
Practice Address - Phone:702-869-8840
Practice Address - Fax:702-240-0481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVS7-241223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty