# DR. LARRY JOHNSON ELLISON

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

## Provider details

- **NPI number:** 1235236217
- **Gender:** Man
- **Credential:** DDS

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223E0200X | Endodontics | 5949 | NE | Yes |

## Other

- **Enumeration date:** 09/20/2006
- **Last updated:** 08/28/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 04989 | BLUE CROSS AND BLUE SHILED | NE |