Provider Demographics
NPI:1508730524
Name:FOUR PEAKS ENDODONTICS, LLC
Entity type:Organization
Organization Name:FOUR PEAKS ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEGLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:623-341-1915
Mailing Address - Street 1:6930 E CHAUNCEY LN STE 110
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85054-5175
Mailing Address - Country:US
Mailing Address - Phone:480-630-0000
Mailing Address - Fax:480-452-1699
Practice Address - Street 1:6930 E CHAUNCEY LN STE 110
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85054-5175
Practice Address - Country:US
Practice Address - Phone:480-630-0000
Practice Address - Fax:480-452-1699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-10-02
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty