| Southlake Endodontics | |
|
1100 E Southlake Blvd Suite 400 Southlake TX 76092-6357 | |
| (817) 488-3636 | |
| (817) 421-2372 |
| Full Name | Southlake Endodontics |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1100 E Southlake Blvd, Southlake, Texas |
| Authorized Official Name and Position | Charles Michael Larsen (MEMBER) |
| Authorized Official Contact | 8174883636 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southlake Endodontics 1100 E Southlake Blvd Suite 400 Southlake TX 76092-6357 Ph: (817) 488-3636 | Southlake Endodontics 1100 E Southlake Blvd Suite 400 Southlake TX 76092-6357 Ph: (817) 488-3636 |
| NPI Number | 1730331778 |
|---|---|
| Provider Enumeration Date | 10/22/2008 |
| Last Update Date | 10/22/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730331778 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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