Provider Demographics
NPI:1306821632
Name:OERTEL, ELLEN RIVES (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:RIVES
Last Name:OERTEL
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2425 BOULEVARD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-2324
Mailing Address - Country:US
Mailing Address - Phone:804-520-0000
Mailing Address - Fax:
Practice Address - Street 1:2425 BOULEVARD
Practice Address - Street 2:SUITE 8
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-2317
Practice Address - Country:US
Practice Address - Phone:804-520-0000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics