Provider Demographics
NPI:1982012803
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:MYCHEL
Authorized Official - Middle Name:M
Authorized Official - Last Name:VAIL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:317-570-9000
Mailing Address - Street 1:10078 LANTERN RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9685
Mailing Address - Country:US
Mailing Address - Phone:317-570-9000
Mailing Address - Fax:
Practice Address - Street 1:10078 LANTERN RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9685
Practice Address - Country:US
Practice Address - Phone:317-570-9000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty