Provider Demographics
NPI:1881894251
Name:ENDODONTIC ASSOCIATES, P.A.
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KANTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:817-283-5544
Mailing Address - Street 1:1100 AIRPORT FWY STE 105
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76022-6658
Mailing Address - Country:US
Mailing Address - Phone:817-283-5544
Mailing Address - Fax:827-283-5873
Practice Address - Street 1:1100 AIRPORT FWY STE 105
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76022-6658
Practice Address - Country:US
Practice Address - Phone:817-283-5544
Practice Address - Fax:817-283-5873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223E0200X
TX81971223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty