Provider Demographics
NPI:1366246308
Name:BOERNE ENDODONTICS PLLC
Entity type:Organization
Organization Name:BOERNE ENDODONTICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TESS
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-431-9205
Mailing Address - Street 1:138 OLD SAN ANTONIO RD STE 501
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-3492
Mailing Address - Country:US
Mailing Address - Phone:830-431-9205
Mailing Address - Fax:830-331-2134
Practice Address - Street 1:138 OLD SAN ANTONIO RD STE 501
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-3492
Practice Address - Country:US
Practice Address - Phone:830-431-9205
Practice Address - Fax:830-331-2134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BOERNE ENDODONTICS PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty