Provider Demographics
NPI:1831756576
Name:ESSENTIAL ENDODONTICS PA
Entity type:Organization
Organization Name:ESSENTIAL ENDODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:D J
Authorized Official - Last Name:YELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-737-7668
Mailing Address - Street 1:3880 HULEN ST STE 310
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107-7274
Mailing Address - Country:US
Mailing Address - Phone:817-737-7668
Mailing Address - Fax:817-377-8950
Practice Address - Street 1:3880 HULEN ST STE 310
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-7274
Practice Address - Country:US
Practice Address - Phone:817-737-7668
Practice Address - Fax:817-377-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1558591511OtherENDODONTIC