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General NPI Number Information
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NPI Number | 1356545180
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Entity Type | Organization
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Legal Business Name | MARISSA RUBIO-ELLIS,DDS,PC
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Dates
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Enumeration Date | 06/14/2007
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Last Update Date | 08/06/2008
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Provider Practice Location Address
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Address Line | 822 E UNION HILLS DR D-6
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City | PHOENIX
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State | AZ
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Zip | 85024-8403
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Country | US
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Telephone | 623-582-6789
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Fax |
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Provider Business Mailing Address
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Address Line | 822 E UNION HILLS DR D-6
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City | PHOENIX
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State | AZ
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Zip | 85024-8403
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Country | US
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Telephone | 623-582-6789
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARISSA RUBIO ELLIS
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Credential | D.D.S.
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Telephone | 623-582-6789
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D4895
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License Number State | AZ
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