Provider Demographics
NPI:1215040738
Name:THE ENDODONTIC GROUP, INC.
Entity type:Organization
Organization Name:THE ENDODONTIC GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:ODDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-361-6669
Mailing Address - Street 1:8201 PRESTON RD
Mailing Address - Street 2:STE 375
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-6203
Mailing Address - Country:US
Mailing Address - Phone:214-361-6669
Mailing Address - Fax:214-361-1847
Practice Address - Street 1:8201 PRESTON RD
Practice Address - Street 2:STE 375
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-6203
Practice Address - Country:US
Practice Address - Phone:214-361-6669
Practice Address - Fax:214-361-1847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109701223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty