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Organization
SPENCER A. ELLIS
Active
Organization
SPENCER A. ELLIS
Active
Other names
Ellis Family Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
SPENCER A. ELLIS D.D.S. (OWNER)
(423) 663-4444
Entity
Organization
Contact information
Practice address
170 SCOTT HIGH DR, HUNTSVILLE, TN 37756-4152
(423) 663-4444
(423) 663-4439
Mailing address
PO BOX 209, HUNTSVILLE, TN 37756-0209
(423) 663-4444
(423) 663-4439
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS7646
TN
332BC3200X
Customized Equipment (DME)
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3139906
BLUE CROSS BLUE SHEILD
TN
Enumeration date
01/07/2008
Last updated
10/02/2023
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