Provider Demographics
NPI:1457597056
Name:INFINITE ENDODONTICS NORTH JERSEY
Entity type:Organization
Organization Name:INFINITE ENDODONTICS NORTH JERSEY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT CYR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-985-4350
Mailing Address - Street 1:401 COMMERCE DRIVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034
Mailing Address - Country:US
Mailing Address - Phone:215-646-6188
Mailing Address - Fax:215-646-6369
Practice Address - Street 1:485 US ROUTE 1 & PLAINFIELD AVENUE
Practice Address - Street 2:
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08117
Practice Address - Country:US
Practice Address - Phone:732-985-4350
Practice Address - Fax:732-819-7669
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INFINITE ENDODONTICS NORTH JERSEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-01-02
Last Update Date:2009-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI020716001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty