Provider Demographics
NPI:1518793355
Name:FIRST STATE ENDODONTICS, LLC
Entity type:Organization
Organization Name:FIRST STATE ENDODONTICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:TEDI
Authorized Official - Middle Name:
Authorized Official - Last Name:VATNIKA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:302-274-0130
Mailing Address - Street 1:4420 LIMESTONE RD STE 208
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2005
Mailing Address - Country:US
Mailing Address - Phone:302-274-0130
Mailing Address - Fax:302-274-0140
Practice Address - Street 1:4420 LIMESTONE RD STE 208
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2005
Practice Address - Country:US
Practice Address - Phone:302-274-0130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-09
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty