Provider Demographics
NPI:1134783145
Name:ENDODONTIC ARTISTRY OF WAINSCOTT PC
Entity type:Organization
Organization Name:ENDODONTIC ARTISTRY OF WAINSCOTT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:JOUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-404-5261
Mailing Address - Street 1:PO BOX 1209
Mailing Address - Street 2:
Mailing Address - City:WAINSCOTT
Mailing Address - State:NY
Mailing Address - Zip Code:11975-1209
Mailing Address - Country:US
Mailing Address - Phone:631-319-8115
Mailing Address - Fax:
Practice Address - Street 1:384 MONTAUK HWY STE 4
Practice Address - Street 2:
Practice Address - City:WAINSCOTT
Practice Address - State:NY
Practice Address - Zip Code:11975-2000
Practice Address - Country:US
Practice Address - Phone:631-319-8115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty