Provider Demographics
NPI:1710080809
Name:ENDODONTIC SPECIALISTS PA
Entity Type:Organization
Organization Name:ENDODONTIC SPECIALISTS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:A
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:952-927-8694
Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:SUITE #665
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-927-8694
Mailing Address - Fax:952-927-8695
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE #665
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-927-8694
Practice Address - Fax:952-927-8695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty