# SOUTHSIDE ENDODONTICS, PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053494260
- **Authorized official:** DR. ELLEN RIVES OERTEL DDS (OWNER)
- **Authorized official phone:** (804) 520-0000

## Contact information

- **Practice address:** 2425 BOULEVARD, SUITE 8, COLONIAL HEIGHTS, VA 23834-2324
- **Practice address phone:** (804) 520-0000
- **Practice address fax:** (804) 520-2111
- **Mailing address:** 2425 BOULEVARD, SUITE 8, COLONIAL HEIGHTS, VA 23834-2324
- **Mailing address phone:** (804) 520-0000
- **Mailing address fax:** (804) 520-2111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 401007706 | VA | Yes |

## Other

- **Enumeration date:** 10/23/2006
- **Last updated:** 03/06/2009