Provider Demographics
NPI:1669751939
Name:PROFESSIONAL ENDODONTICS LL
Entity type:Organization
Organization Name:PROFESSIONAL ENDODONTICS LL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MILOS
Authorized Official - Middle Name:R
Authorized Official - Last Name:JANICEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-447-2572
Mailing Address - Street 1:70 HOWARD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-4937
Mailing Address - Country:US
Mailing Address - Phone:860-447-2572
Mailing Address - Fax:860-447-2638
Practice Address - Street 1:70 HOWARD ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-4937
Practice Address - Country:US
Practice Address - Phone:860-447-2572
Practice Address - Fax:860-447-2638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty