Provider Demographics
NPI:1972789451
Name:ERIE ENDODONTIC ASSOCIATES PC
Entity type:Organization
Organization Name:ERIE ENDODONTIC ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARLIND
Authorized Official - Middle Name:H
Authorized Official - Last Name:STILES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-452-6345
Mailing Address - Street 1:3308 STATE STREET
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2830
Mailing Address - Country:US
Mailing Address - Phone:814-452-6345
Mailing Address - Fax:814-456-8193
Practice Address - Street 1:3308 STATE STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2830
Practice Address - Country:US
Practice Address - Phone:814-452-6345
Practice Address - Fax:814-456-8193
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty