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NPI Code Detail

MEDICARE: ELLIS K. LIST, D.D.S., P.A.

MEDICARE: ELLIS K. LIST, D.D.S., P.A.
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 Dentistry5687NC

General Provider Information

NPI Number : 1821124256
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELLIS K. LIST, D.D.S., P.A.
Provider Business Mailing Address
First Line : 1014 LAMOND AVE
Second Line :
City : DURHAM
State : NC
Zip : 27701-2021
Country : US
Telephone Number : 919-682-5327
Fax Number : 919-688-4588
Provider Business Practice Location Address
First Line : 1014 LAMOND AVE
Second Line :
City : DURHAM
State : NC
Zip : 27701-2021
Country : US
Telephone Number : 919-682-5327
Fax Number : 919-688-4588
Authorized Official
Title or Position : PRESIDENT
Name : DR. ELLIS KNOX LIST
Credential : D.D.S.
Telephone Number : 919-682-5327
Provider Enumeration Date : 02/27/2007
Last Update Date : 07/29/2008

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Practice Location Address:
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Directions to “ELLIS K. LIST, D.D.S., P.A. ” Practice Location

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