Provider Demographics
NPI:1831853290
Name:ADVANCED ENDODONTICS OF VOLUSIA, P.A.
Entity type:Organization
Organization Name:ADVANCED ENDODONTICS OF VOLUSIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:352-404-5550
Mailing Address - Street 1:743 STIRLING CENTER PL STE 1701
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5712
Mailing Address - Country:US
Mailing Address - Phone:352-404-5550
Mailing Address - Fax:407-674-2539
Practice Address - Street 1:1974 FL 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168
Practice Address - Country:US
Practice Address - Phone:352-404-5550
Practice Address - Fax:407-674-2539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental