Provider Demographics
NPI:1821520776
Name:ULTRA ENDODONTICS, LLC
Entity Type:Organization
Organization Name:ULTRA ENDODONTICS, LLC
Other - Org Name:ULTRA ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:ENRIQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:OLTRA ESPLUGUES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:757-250-5285
Mailing Address - Street 1:1092 BLUE CASTLE LN
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-1939
Mailing Address - Country:US
Mailing Address - Phone:206-335-4494
Mailing Address - Fax:757-315-8180
Practice Address - Street 1:7198 CHAPMAN DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HAYES
Practice Address - State:VA
Practice Address - Zip Code:23072-3416
Practice Address - Country:US
Practice Address - Phone:757-250-5285
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414309261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental