SOUTHSIDE ENDODONTICS PC NPI 1053494260

NPI Information

  • NPI: 1053494260
  • Provider Name: SOUTHSIDE ENDODONTICS, PC
  • Classification: Dentist - 1223E0200X
  • Specialization: Endodontics
  • Entity Type: Organization
  • Address: 2425 BOULEVARD
    SUITE 8
    COLONIAL HEIGHTS, VA
    ZIP 23834
  • Phone: (804) 520-0000

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NPI Details

SOUTHSIDE ENDODONTICS, PC is an endodontics dentist in Colonial Heights, VA. The provider is 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. SOUTHSIDE ENDODONTICS, PC NPI is 1053494260. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2425 BOULEVARD
SUITE 8
COLONIAL HEIGHTS, VA
ZIP 23834-324
Phone: (804) 520-0000
Fax: (804) 520-2111

The provider's authorized official is Ellen Rives Oertel .
The authorized official title is Owner and has the following contact phone number (804) 520-0000.

The enumeration date for this NPI number is 10/23/2006 and was last updated on 3/6/2009.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223E0200XDentistEndodontics401007706VIRGINIAYes

What is NPI?

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This page was last updated on: 11/21/2025

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