Provider Demographics
NPI:1366568404
Name:AE ASSOCIATED ENDODONTISTS, P.C
Entity type:Organization
Organization Name:AE ASSOCIATED ENDODONTISTS, P.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-562-0457
Mailing Address - Street 1:500 CHAPMAN ST FL 1
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-2093
Mailing Address - Country:US
Mailing Address - Phone:781-562-0457
Mailing Address - Fax:
Practice Address - Street 1:1 BELMONT AVE STE 316
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-1604
Practice Address - Country:US
Practice Address - Phone:215-477-8941
Practice Address - Fax:215-477-8943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028139L1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty