Provider Demographics
NPI:1770687014
Name:ENDODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES
Other - Org Name:ENDODONTIC ASSOCIATES DRS ILDIKO E BAKOS & CRAIG J TYLER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:ILDIKO
Authorized Official - Middle Name:EYDIE
Authorized Official - Last Name:BAKOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:440-333-1007
Mailing Address - Street 1:22255 CENTER RIDGE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116
Mailing Address - Country:US
Mailing Address - Phone:440-333-1007
Mailing Address - Fax:440-333-1229
Practice Address - Street 1:22255 CENTER RIDGE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116
Practice Address - Country:US
Practice Address - Phone:440-333-1007
Practice Address - Fax:440-333-1229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300186601223E0200X
OH300192571223E0200X
OH300114191223E0200X
OH300201411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty