Healthcare Provider Details

I. General information

NPI: 1841397007
Provider Name (Legal Business Name): DAVID CHAD ELLIS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2524 HIGHWAY 41 S
GREENBRIER TN
37073-4544
US

IV. Provider business mailing address

2524 HIGHWAY 41 S
GREENBRIER TN
37073-4544
US

V. Phone/Fax

Practice location:
  • Phone: 615-643-4006
  • Fax: 615-643-8610
Mailing address:
  • Phone: 615-643-4006
  • Fax: 615-643-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS7699
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: