Provider Demographics
NPI:1285906099
Name:ENDODONTICS ASSOCIATES LLC
Entity type:Organization
Organization Name:ENDODONTICS ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:DAMARIES
Authorized Official - Middle Name:
Authorized Official - Last Name:CANDELARIO-SOTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-605-6507
Mailing Address - Street 1:110 PAYTON LORIANE DR
Mailing Address - Street 2:
Mailing Address - City:POWDER SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30127-8342
Mailing Address - Country:US
Mailing Address - Phone:770-605-6507
Mailing Address - Fax:
Practice Address - Street 1:5255 STILESBORO RD NW STE 130
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7739
Practice Address - Country:US
Practice Address - Phone:770-605-6507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0114921223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty