# DR. ROBERT H. ELLIS III

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1023079654
- **Gender:** Man
- **Credential:** DMD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223P0221X | Pediatric Dentistry | 3691 | SC | Yes |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 10406 | SC | — |

## Other

- **Enumeration date:** 03/31/2006
- **Last updated:** 04/10/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | ZA9724 | — | SC |
| 05 | — | ZX3691 | — | SC |