Provider Demographics
NPI:1811033111
Name:PROFESSIONAL ENDODONTICS OF PINELLAS COUNTY PA
Entity Type:Organization
Organization Name:PROFESSIONAL ENDODONTICS OF PINELLAS COUNTY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:HELEN
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:727-384-4255
Mailing Address - Street 1:509 PASADENA AVENUE SOUTH
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707
Mailing Address - Country:US
Mailing Address - Phone:727-384-4255
Mailing Address - Fax:727-384-4264
Practice Address - Street 1:509 PASADENA AVENUE SOUTH
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707
Practice Address - Country:US
Practice Address - Phone:727-384-4255
Practice Address - Fax:727-384-4264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN155221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty