Provider Demographics
NPI:1740375211
Name:ENDODONTIC ASSOCIATES OF GAINESVILLE, PA
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF GAINESVILLE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:Z
Authorized Official - Last Name:TYLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-331-3113
Mailing Address - Street 1:340 NW 76TH DRIVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-331-3113
Mailing Address - Fax:352-331-5950
Practice Address - Street 1:340 NW 76TH DRIVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-331-3113
Practice Address - Fax:352-331-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty