Provider Demographics
NPI:1912237538
Name:ENDODONTIC SPECIALTY SERVICES, LLC
Entity Type:Organization
Organization Name:ENDODONTIC SPECIALTY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-598-6200
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE A-150
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-598-6200
Mailing Address - Fax:305-598-8253
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE A-150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-598-6200
Practice Address - Fax:305-598-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-04
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 64541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty