Provider Demographics
NPI:1912391863
Name:ENDODONTICS ASSOCIATES LLC
Entity Type:Organization
Organization Name:ENDODONTICS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAMARIES
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO-SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-499-2102
Mailing Address - Street 1:1690 STONE VILLAGE LN NW STE 922
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30152-7714
Mailing Address - Country:US
Mailing Address - Phone:770-499-2102
Mailing Address - Fax:
Practice Address - Street 1:1690 STONE VILLAGE LN NW STE 922
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7714
Practice Address - Country:US
Practice Address - Phone:770-499-2102
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental