Provider Demographics
NPI:1336522721
Name:NORTHSIDE ENDODONTICS, P.C.
Entity Type:Organization
Organization Name:NORTHSIDE ENDODONTICS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUNCAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:317-900-7385
Mailing Address - Street 1:341 LOGAN ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-1557
Mailing Address - Country:US
Mailing Address - Phone:317-900-7385
Mailing Address - Fax:
Practice Address - Street 1:341 LOGAN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-1557
Practice Address - Country:US
Practice Address - Phone:317-900-7385
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009856A1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty