Provider Demographics
NPI:1023687258
Name:ENDODONTIC PRACTICE PARTNERS MA PLLC
Entity type:Organization
Organization Name:ENDODONTIC PRACTICE PARTNERS MA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLUETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-399-7433
Mailing Address - Street 1:PO BOX 1584
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-1584
Mailing Address - Country:US
Mailing Address - Phone:615-422-6700
Mailing Address - Fax:
Practice Address - Street 1:1 BROOKLINE PL STE 505
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7277
Practice Address - Country:US
Practice Address - Phone:617-735-8500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-22
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty