Provider Demographics
NPI:1194967661
Name:PRECISION ENDODONTICS, PLLC
Entity type:Organization
Organization Name:PRECISION ENDODONTICS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RIVERO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:425-252-6666
Mailing Address - Street 1:4225 HOYT AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-2351
Mailing Address - Country:US
Mailing Address - Phone:425-252-6666
Mailing Address - Fax:888-456-0249
Practice Address - Street 1:4225 HOYT AVE
Practice Address - Street 2:SUITE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-2351
Practice Address - Country:US
Practice Address - Phone:425-252-6666
Practice Address - Fax:888-456-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000109231223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty