Provider Demographics
NPI:1093837825
Name:ENDODONTIC SPECIALISTS OF CO, P.C.
Entity Type:Organization
Organization Name:ENDODONTIC SPECIALISTS OF CO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:ISHLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:719-599-7665
Mailing Address - Street 1:5745 ERINDALE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-8926
Mailing Address - Country:US
Mailing Address - Phone:719-599-7665
Mailing Address - Fax:719-599-8599
Practice Address - Street 1:5745 ERINDALE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-8926
Practice Address - Country:US
Practice Address - Phone:719-599-7665
Practice Address - Fax:719-599-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1048241223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty