Provider Demographics
NPI:1205030319
Name:SOUTHLANDS ENDODONTICS, PC
Entity Type:Organization
Organization Name:SOUTHLANDS ENDODONTICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:ISAAC
Authorized Official - Last Name:WHITNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-397-7668
Mailing Address - Street 1:10450 PARK MEADOWS DR STE 102
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5528
Mailing Address - Country:US
Mailing Address - Phone:303-397-7668
Mailing Address - Fax:303-397-7661
Practice Address - Street 1:6240 S MAIN ST STE 285
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-5321
Practice Address - Country:US
Practice Address - Phone:303-366-7668
Practice Address - Fax:303-366-7669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN82121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODEN8212OtherDENTIST LICENSE