Provider Demographics
NPI:1396881389
Name:ADVANCED ENDODONTICS PC
Entity type:Organization
Organization Name:ADVANCED ENDODONTICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SEIDBERG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-453-3636
Mailing Address - Street 1:5112 W TAFT RD
Mailing Address - Street 2:SUITE 'R'
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-4868
Mailing Address - Country:US
Mailing Address - Phone:315-453-3636
Mailing Address - Fax:315-466-3636
Practice Address - Street 1:5112 W TAFT RD
Practice Address - Street 2:SUITE 'R'
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-4868
Practice Address - Country:US
Practice Address - Phone:315-453-3636
Practice Address - Fax:315-466-3636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0241911223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty