Provider Demographics
NPI:1861642076
Name:ENDODONTIC ASSOCIATES OF BAYSIDE, PLLC
Entity Type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF BAYSIDE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:PANAGOPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-224-4000
Mailing Address - Street 1:58-47 FRANCIS LEWIS BLVD
Mailing Address - Street 2:SUITE 12
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1601
Mailing Address - Country:US
Mailing Address - Phone:718-224-4000
Mailing Address - Fax:718-224-1921
Practice Address - Street 1:58-47 FRANCIS LEWIS BLVD
Practice Address - Street 2:SUITE 12
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11364-1601
Practice Address - Country:US
Practice Address - Phone:718-224-4000
Practice Address - Fax:718-224-1921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0323221223E0200X
NY0472741223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty