Organization
SOUTHSIDE ENDODONTICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN RIVES OERTEL DDS (OWNER)
(804) 520-0000
Entity
Organization
Contact information
Practice address
2425 BOULEVARD, SUITE 8, COLONIAL HEIGHTS, VA 23834-2324
(804) 520-0000
(804) 520-2111
Mailing address
2425 BOULEVARD, SUITE 8, COLONIAL HEIGHTS, VA 23834-2324
(804) 520-0000
(804) 520-2111
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
401007706
VA
Other
Enumeration date
10/23/2006
Last updated
03/06/2009
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