Provider Demographics
NPI:1891874988
Name:ENDODONTIC SPECIALISTS
Entity Type:Organization
Organization Name:ENDODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUDOLPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANTELME
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-687-3131
Mailing Address - Street 1:13 BRANCH ST
Mailing Address - Street 2:
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1975
Mailing Address - Country:US
Mailing Address - Phone:978-687-3131
Mailing Address - Fax:978-687-7009
Practice Address - Street 1:13 BRANCH ST
Practice Address - Street 2:
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1975
Practice Address - Country:US
Practice Address - Phone:978-687-3131
Practice Address - Fax:978-687-7009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAX11812OtherBLUE CROSS BLUE SHIELD