Provider Demographics
NPI:1700189198
Name:MIDWEST ENDODONTICS ASSOCIATES
Entity Type:Organization
Organization Name:MIDWEST ENDODONTICS ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-424-9404
Mailing Address - Street 1:17W662 BUTTERFIELD RD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:OAKBROOK TERRACE
Mailing Address - State:IL
Mailing Address - Zip Code:60181-4098
Mailing Address - Country:US
Mailing Address - Phone:630-953-0030
Mailing Address - Fax:
Practice Address - Street 1:17W662 BUTTERFIELD RD
Practice Address - Street 2:SUITE 208
Practice Address - City:OAKBROOK TERRACE
Practice Address - State:IL
Practice Address - Zip Code:60181-4098
Practice Address - Country:US
Practice Address - Phone:630-953-0030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-07
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0265131223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty