# ENDODONTIC ASSOCIATES, INC.

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

## Provider details

- **NPI number:** 1528112562
- **Authorized official:** JUDY E SHIVELY (OFFICE MANAGER)
- **Authorized official phone:** (260) 432-2813

## Contact information

- **Practice address:** 4640 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
- **Practice address phone:** (260) 432-2813
- **Mailing address:** 4640 W JEFFERSON BLVD, FORT WAYNE, IN 46804-6826
- **Mailing address phone:** (260) 432-2813

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 12007603 | IN | Yes |
| 1223E0200X | Endodontics | 12007705 | IN | — |
| 1223E0200X | Endodontics | 12007721 | IN | — |
| 1223E0200X | Endodontics | 12010480 | IN | — |

## Other

- **Enumeration date:** 01/23/2007
- **Last updated:** 08/22/2020