Provider Demographics
NPI:1063085207
Name:ALLIANCE ENDODONTICS PLLC
Entity type:Organization
Organization Name:ALLIANCE ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:N
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-553-8484
Mailing Address - Street 1:2287 RALEIGH CT STE A
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2061
Mailing Address - Country:US
Mailing Address - Phone:931-553-8484
Mailing Address - Fax:
Practice Address - Street 1:2287 RALEIGH CT STE A
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-2061
Practice Address - Country:US
Practice Address - Phone:931-553-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-23
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1841701497Medicaid
TN1427015080Medicaid