Provider Demographics
NPI:1861544256
Name:SUPERSTITION SPRINGS ENDODONTICS, LLP
Entity type:Organization
Organization Name:SUPERSTITION SPRINGS ENDODONTICS, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-807-8022
Mailing Address - Street 1:6755 E SUPERSTITION SPRINGS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4375
Mailing Address - Country:US
Mailing Address - Phone:480-807-8022
Mailing Address - Fax:480-807-5955
Practice Address - Street 1:6755 E SUPERSTITION SPRINGS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4375
Practice Address - Country:US
Practice Address - Phone:480-807-8022
Practice Address - Fax:480-807-5955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty