Provider Demographics
NPI:1982813804
Name:WEST FLORIDA ENDODONTICS, PA
Entity Type:Organization
Organization Name:WEST FLORIDA ENDODONTICS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:DENUNZIO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:850-474-0565
Mailing Address - Street 1:6111 N DAVIS HWY STE B
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6913
Mailing Address - Country:US
Mailing Address - Phone:850-474-0565
Mailing Address - Fax:850-474-0057
Practice Address - Street 1:6111 N DAVIS HWY STE B
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6913
Practice Address - Country:US
Practice Address - Phone:850-474-0565
Practice Address - Fax:850-474-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty