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Individual
DR. CHARLES LEE ELLIS
Active
Individual
DR. CHARLES LEE ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8919
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
019022235
IL
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
0401411258
VA
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
8919
NC
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
0101058265
VA
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
8919
NC
Other
Enumeration date
10/18/2006
Last updated
08/20/2025
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