Provider Demographics
NPI:1295100576
Name:OWENSBORO ENDODONTICS, PSC
Entity type:Organization
Organization Name:OWENSBORO ENDODONTICS, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABIGAIL
Authorized Official - Middle Name:C
Authorized Official - Last Name:EDDS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-421-5115
Mailing Address - Street 1:2200 E PARRISH AVE STE 103C
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1450
Mailing Address - Country:US
Mailing Address - Phone:270-421-5115
Mailing Address - Fax:
Practice Address - Street 1:2200 E PARRISH AVE STE 103C
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1450
Practice Address - Country:US
Practice Address - Phone:270-421-5115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY9591223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty