Provider Demographics
NPI:1780492298
Name:OLIVE BRANCH ENDODONTICS PLLC
Entity type:Organization
Organization Name:OLIVE BRANCH ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HORWAT
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER/DMD
Authorized Official - Phone:615-707-2090
Mailing Address - Street 1:40 W CALDWELL ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MT JULIET
Mailing Address - State:TN
Mailing Address - Zip Code:37122-3179
Mailing Address - Country:US
Mailing Address - Phone:615-808-0027
Mailing Address - Fax:
Practice Address - Street 1:40 W CALDWELL ST STE 203
Practice Address - Street 2:
Practice Address - City:MT JULIET
Practice Address - State:TN
Practice Address - Zip Code:37122-3179
Practice Address - Country:US
Practice Address - Phone:615-808-0027
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1124081997OtherINDIVIDUAL NPI