Provider Demographics
NPI:1972227684
Name:INNOVATIVE ENDODONTICS
Entity Type:Organization
Organization Name:INNOVATIVE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-899-7668
Mailing Address - Street 1:2900 N MAIN ST STE G
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-8451
Mailing Address - Country:US
Mailing Address - Phone:843-899-7668
Mailing Address - Fax:843-899-7667
Practice Address - Street 1:2900 N MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-8451
Practice Address - Country:US
Practice Address - Phone:843-899-7668
Practice Address - Fax:843-899-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty