Provider Demographics
NPI:1669515482
Name:ADVANCED ENDODONTICS PC
Entity type:Organization
Organization Name:ADVANCED ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:HIRSCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:248-668-9103
Mailing Address - Street 1:39525 W 14 MILE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-1632
Mailing Address - Country:US
Mailing Address - Phone:248-668-9103
Mailing Address - Fax:248-668-9114
Practice Address - Street 1:39525 W 14 MILE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48377-1632
Practice Address - Country:US
Practice Address - Phone:248-668-9103
Practice Address - Fax:248-668-9114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174451223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty