Healthcare Provider Details

I. General information

NPI: 1245166552
Provider Name (Legal Business Name): ANNA CLAIRE ELLIS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2026
Last Update Date: 06/23/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 BUCKWALTER PKWY
BLUFFTON SC
29910-5151
US

IV. Provider business mailing address

824 COBORN CT
SARTELL MN
56377-2290
US

V. Phone/Fax

Practice location:
  • Phone: 843-837-2035
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDGD.11507.GD
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: