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General NPI Number Information
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NPI Number | 1285108563
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Entity Type | Organization
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Legal Business Name | ELLIS ENDODONTICS, PA
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Dates
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Enumeration Date | 01/19/2019
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Last Update Date | 01/19/2019
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Provider Practice Location Address
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Address Line | 303 LONGMIRE RD UNIT 901
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City | CONROE
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State | TX
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Zip | 77304-2101
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Country | US
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Telephone | 936-760-2222
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Fax | 936-760-2233
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Provider Business Mailing Address
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Address Line | 303 LONGMIRE RD UNIT 901
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City | CONROE
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State | TX
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Zip | 77304-2101
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Country | US
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Telephone | 936-760-2222
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Fax | 936-760-2233
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Authorized Official
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Title or Position | DOCTOR-OWNER
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Name | DR. GREGORY BRANT ELLIS
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Credential | DDS, MSCD
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Telephone | 832-452-3169
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number |
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License Number State |
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