Provider Demographics
NPI:1760987614
Name:REDLANDS ENDODONTICS
Entity Type:Organization
Organization Name:REDLANDS ENDODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:
Authorized Official - First Name:JENELLE
Authorized Official - Middle Name:MEREDITH
Authorized Official - Last Name:SILVERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:717-514-8227
Mailing Address - Street 1:245 TERRACINA BLVD STE 207B
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4869
Mailing Address - Country:US
Mailing Address - Phone:909-798-2228
Mailing Address - Fax:909-798-2224
Practice Address - Street 1:245 TERRACINA BLVD SUITE 207 B
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-798-2228
Practice Address - Fax:909-798-2224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA599041223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1053613968OtherINDIVIDUAL NPI