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General NPI Number Information
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NPI Number | 1952749152
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Entity Type | Individual
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Provider Name | WILLIAM S DENTE ELLIS D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2013
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 1940 CARSWELL AVE BLDG 7002
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City | LACKLAND AFB
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State | TX
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Zip | 78236-5514
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Country | US
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Telephone | 210-916-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 1940 CARSWELL AVE BLDG 7002
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City | LACKLAND AFB
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State | TX
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Zip | 78236-5514
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Country | US
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Telephone | 210-916-9900
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | V1439
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1267
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License Number State | NE
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