NPIMap

Organization Active NPI

Endodontic Specialist, P.C.

  • Endodontics
  • Wayne, PA
National Provider Identifier
1528116738
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
DS-025210L Issued in PA
Legal business name
ENDODONTIC SPECIALIST, P.C.
Practice address
85 Old Eagle School Rd
Wayne, PA 19087-2544
Phone
(610) 995-0109
Fax
(610) 995-0107
NPI assigned
Jan 7, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Bruce R Terry, D.M.D
Title
Owner
Phone
(610) 995-0109

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X DS-025210L PA Primary

Addresses

Primary practice location

85 Old Eagle School Rd
Wayne, PA 19087-2544

Mailing address

85 Old Eagle School Rd
Wayne, PA 19087-2544
Phone (610) 995-0109

Other identifiers 1

IdentifierTypeStateIssuer
DS-025210LOtherPADENTAL LICENSE

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1168128000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1528116738",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "85 OLD EAGLE SCHOOL RD",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190872544",
            "telephone_number": "610-995-0109",
            "fax_number": "610-995-0107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "85 OLD EAGLE SCHOOL RD",
            "city": "WAYNE",
            "state": "PA",
            "postal_code": "190872544",
            "telephone_number": "610-995-0109",
            "fax_number": "610-995-0107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ENDODONTIC SPECIALIST, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TERRY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "610-995-0109",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "PA",
            "license": "DS-025210L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "DS-025210L",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wayne, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.