Provider Demographics
NPI:1952731887
Name:EAST ORANGE ENDODONTICS
Entity Type:Organization
Organization Name:EAST ORANGE ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVARRIAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-704-7863
Mailing Address - Street 1:10800 DYLAN LOREN CIR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-4437
Mailing Address - Country:US
Mailing Address - Phone:407-704-7863
Mailing Address - Fax:321-248-0330
Practice Address - Street 1:10800 DYLAN LOREN CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4437
Practice Address - Country:US
Practice Address - Phone:407-704-7863
Practice Address - Fax:321-248-0330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental