Provider Demographics
NPI:1740355023
Name:PURCHASE ENDODONTICS LLC
Entity type:Organization
Organization Name:PURCHASE ENDODONTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:D
Authorized Official - Last Name:SERTZINGER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-534-8881
Mailing Address - Street 1:3429 LONE OAK RD
Mailing Address - Street 2:STE 1
Mailing Address - City:PDUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-534-8881
Mailing Address - Fax:270-534-0115
Practice Address - Street 1:3429 LONE OAK RD
Practice Address - Street 2:STE 1
Practice Address - City:PDUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-534-8881
Practice Address - Fax:270-534-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY70971223E0200X
KY67221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty