# ENDODONTICS PC

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

## Provider details

- **NPI number:** 1538126263
- **Authorized official:** MARIA SHANK (BOOK KEEPER)
- **Authorized official phone:** (313) 565-9118

## Contact information

- **Practice address:** 22731 NEWMAN ST STE 125, DEARBORN, MI 48124
- **Practice address phone:** (313) 565-9118
- **Practice address fax:** (313) 565-2672
- **Mailing address:** 22731 NEWMAN ST STE 125, DEARBORN, MI 48124
- **Mailing address phone:** (313) 565-9118
- **Mailing address fax:** (313) 565-2672

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 10546 | MI | — |
| 1223E0200X | Endodontics | 13637 | MI | — |
| 1223E0200X | Endodontics | 14484 | MI | — |
| 1223E0200X | Endodontics | 16152 | MI | — |
| 1223E0200X | Endodontics | 17362 | MI | — |
| 1223E0200X | Endodontics | 18227 | MI | — |
| 1223E0200X | Endodontics | 8357 | MI | Yes |
| 1223E0200X | Endodontics | 9366 | MI | — |
| 1223E0200X | Endodontics | 9563 | MI | — |

## Other

- **Enumeration date:** 04/27/2006
- **Last updated:** 08/07/2020