Provider Demographics
NPI:1487248951
Name:ENDODONTIC SPECIALISTS
Entity type:Organization
Organization Name:ENDODONTIC SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORY
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-964-8833
Mailing Address - Street 1:5111 EHRLICH RD STE 130
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2074
Mailing Address - Country:US
Mailing Address - Phone:813-964-8833
Mailing Address - Fax:813-964-8883
Practice Address - Street 1:3670 HENDERSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4515
Practice Address - Country:US
Practice Address - Phone:813-871-5900
Practice Address - Fax:813-875-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty