Provider Demographics
NPI:1891998555
Name:PARKRIDGE ENDODONTICS, PC
Entity Type:Organization
Organization Name:PARKRIDGE 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 1:10450 PARK MEADOWS DR STE 102
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5528
Practice Address - Country:US
Practice Address - Phone:303-397-7668
Practice Address - Fax:303-397-7661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN82121223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty