# DRS. ELLIS & MEFFORD DENTAL ASSOCIATES, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1619092152
- **Authorized official:** DR. MILTON KEITH ELLIS D.D.S. (DOCTOR)
- **Authorized official phone:** (423) 434-1370

## Contact information

- **Practice address:** 2806 W MARKET ST, JOHNSON CITY, TN 37604-5166
- **Practice address phone:** (423) 434-1370
- **Practice address fax:** (423) 434-9965
- **Mailing address:** 2806 W MARKET ST, JOHNSON CITY, TN 37604-5166
- **Mailing address phone:** (423) 434-1370
- **Mailing address fax:** (423) 434-9965

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | DS004187 | TN | — |
| 1223G0001X | General Practice Dentistry | DS007966 | TN | Yes |

## Other

- **Enumeration date:** 03/21/2007
- **Last updated:** 08/22/2020