Provider Demographics
NPI:1922452804
Name:ENDODONTICS AND IMPLANT ASSOCIATES,PLLC
Entity Type:Organization
Organization Name:ENDODONTICS AND IMPLANT ASSOCIATES,PLLC
Other - Org Name:ENDODONTICS AND DENTAL IMPLANTS OF OKLAHOMA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:XU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:646-662-3105
Mailing Address - Street 1:1621 MIDTOWN PLACE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130
Mailing Address - Country:US
Mailing Address - Phone:405-982-2121
Mailing Address - Fax:405-561-0120
Practice Address - Street 1:1621 MIDTOWN PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130
Practice Address - Country:US
Practice Address - Phone:405-982-2121
Practice Address - Fax:405-561-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-18
Last Update Date:2016-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK72122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty