Provider Demographics
NPI:1992978761
Name:ENDODONTIC ASSOCIATES OF TRINITY P.A.
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF TRINITY P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CINDI
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-796-2183
Mailing Address - Street 1:8812 HAWBUCK ST
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-5360
Mailing Address - Country:US
Mailing Address - Phone:727-372-8814
Mailing Address - Fax:727-375-7908
Practice Address - Street 1:8812 HAWBUCK ST
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-5360
Practice Address - Country:US
Practice Address - Phone:727-372-8814
Practice Address - Fax:727-375-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00121831223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty