NPIMap

Organization Active NPI

Root Canal Specialty Services Inc

  • Endodontics
  • Fort Wayne, IN
National Provider Identifier
1669589941
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
EndodonticsTaxonomy code 1223E0200X
License
8592 Issued in IN
Legal business name
ROOT CANAL SPECIALTY SERVICES INC
Practice address
4636 W Jefferson Blvd
Fort Wayne, IN 46804
Phone
(260) 436-9439
Fax
(260) 436-9467
NPI assigned
Aug 24, 2006
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
Robert Todd MabryNPI 1407933427
Title
President
Phone
(260) 436-9439

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
EndodonticsGroup: 193400000X SINGLE SPECIALTY GROUP 1223E0200X 8592 IN Primary

Addresses

Primary practice location

4636 W Jefferson Blvd
Fort Wayne, IN 46804

Mailing address

4636 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 436-9439

National Provider Directory

National Provider Directory

Locations

4636 W Jefferson Blvd
Fort Wayne, IN 46804
Phone (260) 436-9439

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1669589941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4636 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-436-9439",
            "fax_number": "260-436-9467"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4636 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-436-9439",
            "fax_number": "260-436-9467"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROOT CANAL SPECIALTY SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MABRY",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "TODD",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "260-436-9439"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Endodontics",
            "state": "IN",
            "license": "8592",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Wayne, IN

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.