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General NPI Number Information
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NPI Number | 1235347436
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Entity Type | Individual
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Provider Name | GEORGE E ELLIS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 108 TRADE CENTER LN
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City | HAZLEHURST
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State | MS
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Zip | 39083-2319
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Country | US
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Telephone | 601-894-4016
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Fax | 601-894-1751
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Provider Business Mailing Address
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Address Line | 108 TRADE CENTER LN
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City | HAZLEHURST
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State | MS
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Zip | 39083-2319
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Country | US
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Telephone | 601-894-4016
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Fax | 601-894-1751
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 233687
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License Number State | MS
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