Provider Demographics
NPI:1720258205
Name:ENDODONTIC SPECIALISTS, PC
Entity Type:Organization
Organization Name:ENDODONTIC SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-413-1100
Mailing Address - Street 1:4820 W TAFT RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-2800
Mailing Address - Country:US
Mailing Address - Phone:315-413-1100
Mailing Address - Fax:315-413-0710
Practice Address - Street 1:4820 W TAFT RD
Practice Address - Street 2:SUITE 214
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-2800
Practice Address - Country:US
Practice Address - Phone:315-413-1100
Practice Address - Fax:315-413-0710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY378911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty