Organization
ENDODONTIC SPECIALIST, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE R TERRY D.M.D (OWNER)
(610) 995-0109
Entity
Organization
Contact information
Practice address
85 OLD EAGLE SCHOOL RD, WAYNE, PA 19087-2544
(610) 995-0109
(610) 995-0107
Mailing address
85 OLD EAGLE SCHOOL RD, WAYNE, PA 19087-2544
(610) 995-0109
(610) 995-0107
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
DS-025210L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DS-025210L
DENTAL LICENSE
PA
Enumeration date
01/07/2007
Last updated
08/22/2020
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