Individual provider · NPI-1

Dr. Randall A. Ellis, D.D.S.

Dentist, General Practice · Texarkana, AR

NPI number1740328046
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1740328046
Entity type
Individual (NPI-1)
Name
Dr. Randall A. Ellis
Credential
D.D.S.
Sex
Male
Sole proprietor
Yes
Enumeration date
Feb 1, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
1223G0001X Dentist, General Practice3050ARYes

Practice location

312 Arkansas Blvd
Texarkana, AR 71854-1905

Phone 870-772-1374 · Fax 870-774-6814

Mailing address

312 Arkansas Blvd
Texarkana, AR 71854-1905

Phone 870-772-1374 · Fax 870-774-6814

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