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DR. ELI GEORGE ELLIS DDS

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1326113135

Individual Registrant:
DR. ELI GEORGE ELLIS DDS
Gender: M
Sole Proprietor

Location and contact information for practice:
911 MARKET ST  PORT GIBSON, MS 39150 US
Tel: 601-437-5221  Fax: --

Contact information for business:
PO BOX 237  PORT GIBSON, MS 39150-0237 US
Tel: 601-437-5670  Fax: --

Registration Information:
NPI: 1326113135
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
MS1099-63

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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