Provider Demographics
NPI:1699326603
Name:NORTH CENTRAL FLORIDA ENDODONTICS,PLLC
Entity type:Organization
Organization Name:NORTH CENTRAL FLORIDA ENDODONTICS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-375-7776
Mailing Address - Street 1:1905 NW 13TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3414
Mailing Address - Country:US
Mailing Address - Phone:352-375-7776
Mailing Address - Fax:352-375-1039
Practice Address - Street 1:48 SE 16TH AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-2521
Practice Address - Country:US
Practice Address - Phone:352-629-5898
Practice Address - Fax:352-629-3995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101505400Medicaid
FL101505100Medicaid