Healthcare Provider Details

I. General information

NPI: 1962989194
Provider Name (Legal Business Name): AMANDA ELLING DDS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2018
Last Update Date: 07/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 W PARKER ST STE A
ELKHART TX
75839-7612
US

IV. Provider business mailing address

428 AN COUNTY ROAD 133
ELKHART TX
75839-6104
US

V. Phone/Fax

Practice location:
  • Phone: 903-764-5531
  • Fax:
Mailing address:
  • Phone: 817-709-3006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. AMANDA LEIGH ELLING
Title or Position: OWNER
Credential: DDS
Phone: 903-764-5531