| Southside Endodontics, Pc | |
|
2425 Boulevard Suite 8 Colonial Heights VA 23834-2324 | |
| (804) 520-0000 | |
| (804) 520-2111 |
| Full Name | Southside Endodontics, Pc |
|---|---|
| Speciality | Dentist - Endodontics |
| Location | 2425 Boulevard, Colonial Heights, Virginia |
| Authorized Official Name and Position | Ellen Rives Oertel (OWNER) |
| Authorized Official Contact | 8045200000 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Southside Endodontics, Pc 2425 Boulevard Suite 8 Colonial Heights VA 23834-2324 Ph: (804) 520-0000 | Southside Endodontics, Pc 2425 Boulevard Suite 8 Colonial Heights VA 23834-2324 Ph: (804) 520-0000 |
| NPI Number | 1053494260 |
|---|---|
| Provider Enumeration Date | 10/23/2006 |
| Last Update Date | 03/06/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053494260 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223E0200X | Dentist - Endodontics | 401007706 (Virginia) | Primary |
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