Provider Demographics
NPI:1386783231
Name:ENDODONTIC SPECIALTY SERVICES, PA
Entity type:Organization
Organization Name:ENDODONTIC SPECIALTY SERVICES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-598-6200
Mailing Address - Street 1:7800 SW 87TH AVE
Mailing Address - Street 2:SUITE A-150
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3570
Mailing Address - Country:US
Mailing Address - Phone:305-598-6200
Mailing Address - Fax:305-598-8253
Practice Address - Street 1:7800 SW 87TH AVE
Practice Address - Street 2:SUITE A-150
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3570
Practice Address - Country:US
Practice Address - Phone:305-598-6200
Practice Address - Fax:305-598-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 0064541223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL901308OtherPMI DELTACARE
FL601668OtherCOMPBENEFITS