Provider Demographics
NPI:1316784739
Name:META ENDO PLLC
Entity type:Organization
Organization Name:META ENDO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TAM
Authorized Official - Middle Name:MINH
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:502-319-0611
Mailing Address - Street 1:6504 N OXFORD AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-1529
Mailing Address - Country:US
Mailing Address - Phone:502-319-0611
Mailing Address - Fax:
Practice Address - Street 1:707 LAKE COOK RD STE 300
Practice Address - Street 2:
Practice Address - City:DEERFIELD
Practice Address - State:IL
Practice Address - Zip Code:60015-5276
Practice Address - Country:US
Practice Address - Phone:773-413-9826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-12
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty