Provider Demographics
NPI:1861637308
Name:ENDODONTIC ASSOCIATES
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:GRONEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-272-5800
Mailing Address - Street 1:1434 E 4500 S STE 201
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84117-4252
Mailing Address - Country:US
Mailing Address - Phone:801-272-5800
Mailing Address - Fax:801-272-5897
Practice Address - Street 1:1434 E 4500 S STE 201
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84117-4252
Practice Address - Country:US
Practice Address - Phone:801-272-5800
Practice Address - Fax:801-272-5897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1453999231223E0200X
UT01448989921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty