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Individual
DR. LARRY JOHNSON ELLISON
Active
Individual
DR. LARRY JOHNSON ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
5949
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
04989
BLUE CROSS AND BLUE SHILED
NE
Enumeration date
09/20/2006
Last updated
08/28/2008
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