NORTHWEST ENDODONTIC SPECIALISTS, P.C. (NPI# 1700058302) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1700058302 |
| Entity Type | Organization |
| Organization Name | NORTHWEST ENDODONTIC SPECIALISTS, P.C. |
| Other Organization Name | CANTON OFFICE |
| Practice Address |
2205 Riverstone Blvd Suite 205 Canton GA 30114-5227 |
| Practice Telephone | 6784936693 |
| Practice Fax Number | 6784936694 |
| Mailing Telephone | 6784936693 |
| Mailing Fax Number | 6784936694 |
| Enumeration Date | 2008-03-24 |
| Last Update Date | 2008-03-24 |
| Authorized Official Name | DR. RICHARDSON MICHAEL ODUM (PRESIDENT) |
| Authorized Official Telephone | 6784936693 |
| Authorized Official Credential | DMD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223E0200X |
Dentist Specialization: Endodontics |
10232, 10416 | GA | Dental Providers |
| Other Name | Type Code |
|---|---|
| Canton office | Other Name - Individual/Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801916069 | Northwest Endodontic Specialists, P.C. | Dentist | 271 Heritage Walk, Woodstock, GA 30188-3876 | 2007-03-30 |
| Street Address |
2205 RIVERSTONE BLVD SUITE 205 |
| City | CANTON |
| State | GA |
| Zip Code | 30114-5227 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003264532 | Interventional Spine & Pain Management Center, PC | Pain Medicine | 2205 Riverstone Blvd, Suite 101, Canton, GA 30114-5227 | 2016-05-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619516093 | Wickshire Canton Opco LLC | Assisted Living Facility | 125 Riverstone Terrace, Canton, GA 30114 | 2020-01-02 |
| 1154803583 | Alixandra Nicole Flournoy | Physical Therapist | 131 Holly Street, Canton, GA 30114 | 2018-09-01 |
| 1588157341 | Provident Group - Canton Cove Properties LLC | Alzheimer Center (Dementia Center) | 1100 Reinhardt College Parkway, Canton, GA 30114 | 2018-06-07 |
| 1003233107 | Heartland Dental Care of Georgia | Dentist | 3237 Sixes Rd, Canton, GA 30114 | 2014-03-26 |
| 1730510959 | Joseph Optical | Eyewear Supplier (Equipment, not the service) | 1455 Riverstone Pkwy Suite 110, Canton, GA 30114 | 2013-12-13 |
| 1629313036 | Ramona Morton Rasmussen | Occupational Therapist | 200 Riverstone Drive, Suite B, Canton, GA 30114 | 2012-12-11 |
| 1902154875 | Yong Qiao Luo | Acupuncturist | 200 Oakside Lane, Suite D, Canton, GA 30114 | 2012-08-26 |
| 1215294350 | Christina Lynn Hernandez | Pediatrics | 1558 Riverstone Pkwy Ste 100, Canton, GA 30114 | 2012-04-13 |
| 1558638981 | Stephen E Byrd | Counselor | 191 Lamar Haley Pkwy., Canton, GA 30114 | 2011-11-30 |
| 1073807855 | Sheri Sullins Buckley | Nurse Practitioner | 120 Oakside Ct Ste H, Canton, GA 30114 | 2011-06-08 |
| Find all providers in zip 30114 | ||||
| Taxonomy Code | 1223E0200X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Endodontics |
| The branch of dentistry that is concerned with the morphology, physiology and pathology of the human dental pulp and periradicular tissues. Its study and practice encompass the basic and clinical sciences including biology of the normal pulp, the etiology, diagnosis, prevention and treatment of diseases and injuries of the pulp and associated periradicular conditions. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780950808 | Maria Do Carmo Ciasca | Dentist | 4774 Munson St Nw Ste 300, Canton, OH 44718-3634 | 2012-03-23 |
| 1013171438 | Shaletha M Bolden | Dentist | 1425 Riverstone Pkwy Ste 200, Canton, GA 30114-5611 | 2008-07-15 |
| 1730397811 | Scott Brian Shellhammer | Dentist | 4425 Fulton Dr Nw, Canton, OH 44718-2863 | 2007-05-20 |
| 1649388455 | Michael Stephen Winick | Dentist | 4883 Dressler Rd, Ste 201, Canton, OH 44718 | 2006-08-29 |
| 1164436853 | Philip A. Jensen | Dentist | 4580 Stephens Cir Nw, Suite 102, Canton, OH 44718-3644 | 2006-07-28 |
| 1548274590 | James D. Jensen | Dentist | 4580 Stephen Cir Nw, Suite 102, Canton, OH 44718-3644 | 2006-07-27 |
| 1346212974 | Meckler Dental Providers (belden), Inc. | Dentist | 4220 Belden Village St Nw Unit B, Canton, OH 44718-2536 | 2006-02-07 |
| 1194155986 | Cherokee Family Dental, LLC | Dentist | 2920 Marietta Hwy, Suite 146, Canton, GA 30114-8212 | 2013-11-15 |
| 1164731519 | Dania Kafri | Dentist | 4774 Munson St Nw, Suite 304, Canton, OH 44718-3634 | 2010-10-04 |
| 1427223411 | Jenifer M. Schnettler | Dentist | 4425 Fulton Dr Nw, Canton, OH 44718-2863 | 2008-04-29 |
| Find all providers in CANTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.