Provider Demographics
NPI:1770713265
Name:ENDODONTICS SOUTH, LTD
Entity type:Organization
Organization Name:ENDODONTICS SOUTH, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:636-933-7001
Mailing Address - Street 1:1431 US HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4109
Mailing Address - Country:US
Mailing Address - Phone:636-933-7001
Mailing Address - Fax:636-933-7002
Practice Address - Street 1:1431 US HWY 61 SO
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028
Practice Address - Country:US
Practice Address - Phone:636-933-7001
Practice Address - Fax:636-933-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-20
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0124321223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty