Provider Demographics
NPI:1992370530
Name:WHITE RIVER ENDODONTICS, LLC
Entity Type:Organization
Organization Name:WHITE RIVER ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ETHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-674-3919
Mailing Address - Street 1:9779 E 146TH ST STE 110
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-4327
Mailing Address - Country:US
Mailing Address - Phone:317-674-3919
Mailing Address - Fax:
Practice Address - Street 1:9779 E 146TH ST STE 110
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-4327
Practice Address - Country:US
Practice Address - Phone:317-674-3919
Practice Address - Fax:317-674-3911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty