# RANDAL W ELLIS DMD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ellis Dentistry
- **Organization subpart:** No

## Provider details

- **NPI number:** 1326051285
- **Authorized official:** RANDAL W ELLIS DMD (DENTIST/OWNER)
- **Authorized official phone:** (360) 592-1100

## Contact information

- **Practice address:** 3739 MT BAKER HWY, EVERSON, WA 98247-9406
- **Practice address phone:** (360) 592-1100
- **Practice address fax:** (360) 592-5067
- **Mailing address:** PO BOX 608, DEMING, WA 98244
- **Mailing address phone:** (360) 592-1100
- **Mailing address fax:** (360) 592-5067

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DE00008470 | WA | Yes |

## Other

- **Enumeration date:** 08/14/2006
- **Last updated:** 05/03/2012