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General NPI Number Information
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NPI Number | 1558795930
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Entity Type | Organization
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Legal Business Name | TERRY R. ELLIS, DMD, PC
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Dates
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Enumeration Date | 08/21/2013
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Last Update Date | 08/21/2013
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Provider Practice Location Address
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Address Line | 1244 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1854
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Country | US
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Telephone | 706-855-7220
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Fax | 706-855-7260
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Provider Business Mailing Address
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Address Line | 1244 AUGUSTA WEST PKWY
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City | AUGUSTA
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State | GA
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Zip | 30909-1854
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Country | US
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Telephone | 706-855-7220
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Fax | 706-855-7260
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRY R ELLIS
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Credential | DMD
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Telephone | 706-855-7220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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