Jerry R Ellis DDS PC
Durable Medical Equipment & Medical Supplies, Customized Equipment in Midlothian, TX. Organization (NPI-2).
NPI number1982304267
StatusActive
Last updated in NPPESApr 20, 2023
Details
- NPI
- 1982304267
- Entity type
- Organization (NPI-2)
- Legal business name
- Jerry R Ellis DDS PC
- Organization subpart
- No
- Enumeration date
- Mar 6, 2023
- Certification date
- Apr 20, 2023
- Last updated
- Apr 20, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 332BC3200X | Durable Medical Equipment & Medical Supplies, Customized Equipment | – | – | Yes |
| 261QD0000X | Clinic/Center, Dental | – | – |
Other names
- Jerry R Ellis DDS PC (Other Name)
Practice location
404 W Main StMidlothian, TX 76065-2946
Phone 972-775-2345
Mailing address
404 W Main StMidlothian, TX 76065-2946
Phone 972-775-2345
Authorized official
Jerry R Ellis
Owner/Dentist
9727752345
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