Provider Demographics
NPI:1891751442
Name:ENDODONTIC HEALTH, PC
Entity Type:Organization
Organization Name:ENDODONTIC HEALTH, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:PELAYO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-697-0107
Mailing Address - Street 1:481 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02324-3152
Mailing Address - Country:US
Mailing Address - Phone:508-697-0107
Mailing Address - Fax:508-697-3377
Practice Address - Street 1:481 BEDFORD ST
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02324-3152
Practice Address - Country:US
Practice Address - Phone:508-697-0107
Practice Address - Fax:508-697-3377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-23
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA192781223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty