Provider Demographics
NPI:1982762613
Name:ENDODONTRIC SPECIALTY GROUP, LLC
Entity Type:Organization
Organization Name:ENDODONTRIC SPECIALTY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:KIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-438-4282
Mailing Address - Street 1:3 SW 129TH AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-438-4282
Mailing Address - Fax:954-442-6511
Practice Address - Street 1:3 SW 129TH AVE
Practice Address - Street 2:STE 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-438-4282
Practice Address - Fax:954-442-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty