Provider Demographics
NPI:1053732735
Name:ADVANCED ENDODONTICS OF WELLINGTON
Entity type:Organization
Organization Name:ADVANCED ENDODONTICS OF WELLINGTON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-333-2522
Mailing Address - Street 1:3319 STATE ROAD 7
Mailing Address - Street 2:SUITE 307
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33449-8094
Mailing Address - Country:US
Mailing Address - Phone:561-333-2522
Mailing Address - Fax:561-333-2484
Practice Address - Street 1:3319 STATE ROAD 7
Practice Address - Street 2:SUITE 307
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33449-8094
Practice Address - Country:US
Practice Address - Phone:561-333-2522
Practice Address - Fax:561-333-2484
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED ENDODONTICS OF WELLINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-12-23
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15484261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental