Dr. Taylor Austin Ellson, DMD
Dentist, General Practice in Shady Cove, OR. Individual provider (NPI-1).
NPI number1164038030
StatusActive
Last updated in NPPESSep 16, 2020
Details
- NPI
- 1164038030
- Entity type
- Individual (NPI-1)
- Name
- Dr. Taylor Austin Ellson
- Credential
- DMD
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Sep 16, 2020
- Certification date
- Sep 16, 2020
- Last updated
- Sep 16, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | D11324 | OR | Yes |
Practice location
21300 Highway 62Shady Cove, OR 97539-7707
Phone 541-878-2115 · Fax 541-878-2117
Mailing address
Po Box 1150Shady Cove, OR 97539-1150
Phone 541-878-2115
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