Provider Demographics
NPI:1841639077
Name:PACKER ENDODONTICS
Entity type:Organization
Organization Name:PACKER ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:PACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MSD
Authorized Official - Phone:949-572-4078
Mailing Address - Street 1:26671 ALISO CREEK RD STE 300
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4810
Mailing Address - Country:US
Mailing Address - Phone:949-572-4078
Mailing Address - Fax:708-443-8410
Practice Address - Street 1:26671 ALISO CREEK RD STE 300
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4810
Practice Address - Country:US
Practice Address - Phone:949-572-4078
Practice Address - Fax:708-443-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-20
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA588871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty