Southglenn Dental Care, PC

Primary specialty

EndodonticsTaxonomy code 1223E0200X

Legal business name

SOUTHGLENN DENTAL CARE, PC

Doing business as

SouthGlenn Dental Care, PC

Practice address

6650 S Vine St Ste 200
Centennial, CO 80121-2763

Phone

(303) 797-3636

NPI assigned

Nov 30, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Angela Eiswerth

Title

Credentialing Manager

Phone

(770) 833-0994

Specialties & licenses 2

Addresses

Other names 1

• SouthGlenn Dental Care, PC Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638230400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638835200000",
    "number": "1144988957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7160 DALLAS PKWY STE 400",
            "city": "PLANO",
            "state": "TX",
            "postal_code": "750247111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6650 S VINE ST STE 200",
            "city": "CENTENNIAL",
            "state": "CO",
            "postal_code": "801212763",
            "telephone_number": "303-797-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHGLENN DENTAL CARE, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-30",
        "last_updated": "2021-12-07",
        "certification_date": "2021-12-07",
        "status": "A",
        "authorized_official_last_name": "EISWERTH",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "770-833-0994",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Endodontics",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SouthGlenn Dental Care, PC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• South Psychology LLC
• South Suburban Family Practice P C
• Jordan Southall, PHARMD
• Southeast Counseling & Coaching Center PC
• Southeast Counseling and Coaching
• Southglenn Endodontics
• Southglenn Eyecare, PC
• Southglenn Modern Dentistry, LLP (Southglenn Modern Dentisrty)
• Sowash Optometry Group, PC (Visionworks)
• Dara-Lynn Sowell

• Endodontics in Centennial, CO
• Providers in Centennial, CO by specialty
• Endodontics in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.