# JENKINTOWN ENDODONTICS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386118958
- **Authorized official:** DR. ALEXANDER FULLER DMD (PART OWNER/ ENDODONTIST)
- **Authorized official phone:** (267) 255-0759

## Contact information

- **Practice address:** 509 YORK RD, JENKINTOWN, PA 19046-2102
- **Practice address phone:** (267) 589-9636
- **Mailing address:** 509 YORK RD, JENKINTOWN, PA 19046-2102
- **Mailing address phone:** (267) 589-9636

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | — | NULL | Yes |
| 1223E0200X | Endodontics | — | — | Yes |

## Other

- **Enumeration date:** 01/17/2019
- **Last updated:** 01/17/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1508260274 | NPI | — |