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NPI Code Detail

MEDICARE: RICHARD A. ELLIS DDS

MEDICARE: RICHARD A. ELLIS DDS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN6780FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265537633
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD A. ELLIS DDS
Provider Business Mailing Address
First Line : PO BOX 1357
Second Line :
City : FORT MYERS
State : FL
Zip : 33902-1357
Country : US
Telephone Number : 239-278-3600
Fax Number : 239-278-3857
Provider Business Practice Location Address
First Line : 930 S MAIN ST
Second Line :
City : LABELLE
State : FL
Zip : 33935-4444
Country : US
Telephone Number : 863-675-0387
Fax Number : 863-675-3246
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 04/30/2010

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Directions to “ RICHARD A. ELLIS DDS” Practice Location

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