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RICHARD A. ELLIS DDS

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1265537633

Individual Registrant:
 RICHARD A. ELLIS DDS
Gender: M
Not Sole Proprietor

Location and contact information for practice:
930 S MAIN ST  LABELLE, FL 33935-4444 US
Tel: 863-675-0387  Fax: 863-675-3246

Contact information for business:
PO BOX 1357  FORT MYERS, FL 33902-1357 US
Tel: 239-278-3600  Fax: 239-278-3857

Registration Information:
NPI: 1265537633
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
FLDN6780

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
074342900FL05




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