Provider Demographics
NPI:1427500610
Name:ENDO GROUP PLLC
Entity type:Organization
Organization Name:ENDO GROUP PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:RONALD
Authorized Official - Last Name:KIRSH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-438-4282
Mailing Address - Street 1:3 SW 129TH AVE
Mailing Address - Street 2:STE 205
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027-1775
Mailing Address - Country:US
Mailing Address - Phone:954-438-4282
Mailing Address - Fax:
Practice Address - Street 1:3 SW 129TH AVE
Practice Address - Street 2:STE 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027-1775
Practice Address - Country:US
Practice Address - Phone:954-438-4282
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00133021223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty