Provider Demographics
NPI:1215131578
Name:ENDODONTIC ASSOCIATES LTD
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MCGRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-627-8022
Mailing Address - Street 1:3440 TAMIAMI TRL.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952
Mailing Address - Country:US
Mailing Address - Phone:941-627-8022
Mailing Address - Fax:941-627-5147
Practice Address - Street 1:3440 TAMIAMI TRL
Practice Address - Street 2:SUITE 3
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8134
Practice Address - Country:US
Practice Address - Phone:941-627-8022
Practice Address - Fax:941-627-5147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00126331223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty