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General NPI Number Information
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NPI Number | 1053068064
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Entity Type | Organization
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Legal Business Name | ELLIS DENTISTRY LLC
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Dates
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Enumeration Date | 03/09/2022
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Last Update Date | 03/09/2022
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Provider Practice Location Address
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Address Line | 1101 GLENEAGLES DR SW
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City | HUNTSVILLE
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State | AL
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Zip | 35801-6405
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Country | US
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Telephone | 256-881-4441
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Fax |
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Provider Business Mailing Address
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Address Line | 1603 SANDLIN AVE SE
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City | HUNTSVILLE
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State | AL
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Zip | 35801-2067
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Country | US
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Telephone | 256-881-4441
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. SARAH SCHMIDT ELLIS
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Credential | DMD
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Telephone | 256-881-4441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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