Provider Demographics
NPI:1780691790
Name:ENDODONTIC ASSOCIATES OF NE PA, P.C.
Entity type:Organization
Organization Name:ENDODONTIC ASSOCIATES OF NE PA, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CASSARELLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-331-0824
Mailing Address - Street 1:676 REAR WYOMING AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704
Mailing Address - Country:US
Mailing Address - Phone:570-331-0824
Mailing Address - Fax:570-331-0827
Practice Address - Street 1:676 REAR WYOMING AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704
Practice Address - Country:US
Practice Address - Phone:570-331-0824
Practice Address - Fax:570-331-0827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty