Provider Demographics
NPI:1740934892
Name:ADVANCED ENDODONTIC GROUP
Entity type:Organization
Organization Name:ADVANCED ENDODONTIC GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:INGRID
Authorized Official - Middle Name:E
Authorized Official - Last Name:EPELMAN DORRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-615-6300
Mailing Address - Street 1:1045 KANE CONCOURSE STE 204
Mailing Address - Street 2:
Mailing Address - City:BAY HARBOR ISLANDS
Mailing Address - State:FL
Mailing Address - Zip Code:33154-2119
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1045 KANE CONCOURSE STE 204
Practice Address - Street 2:
Practice Address - City:BAY HARBOR ISLANDS
Practice Address - State:FL
Practice Address - Zip Code:33154-2119
Practice Address - Country:US
Practice Address - Phone:305-615-6300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty