Provider Demographics
NPI:1821185562
Name:NORTHWEST ENDODONTICS LTD
Entity Type:Organization
Organization Name:NORTHWEST ENDODONTICS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:NATHANSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-394-2020
Mailing Address - Street 1:120 W EASTMAN
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-5950
Mailing Address - Country:US
Mailing Address - Phone:847-394-2020
Mailing Address - Fax:847-394-1965
Practice Address - Street 1:120 W EASTMAN
Practice Address - Street 2:SUITE 308
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-5950
Practice Address - Country:US
Practice Address - Phone:847-394-2020
Practice Address - Fax:847-394-1965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty