Provider Demographics
NPI:1104942275
Name:ENDODONTIC ASSOCIATES, L.L.C.
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES, L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETROPOULOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:505-881-6902
Mailing Address - Street 1:7520 MONTGOMERY BLVD NE
Mailing Address - Street 2:BUILDING C, SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1521
Mailing Address - Country:US
Mailing Address - Phone:505-881-6902
Mailing Address - Fax:505-881-7496
Practice Address - Street 1:7520 MONTGOMERY BLVD NE
Practice Address - Street 2:BUILDING C SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1521
Practice Address - Country:US
Practice Address - Phone:505-881-6902
Practice Address - Fax:505-881-7496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2728261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental