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Organization
ELLSWORTH DENTAL LP
Active
Organization
ELLSWORTH DENTAL LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHANE L ELLSWOTH DMD (MANAGING MEMBER)
(503) 476-5242
Entity
Organization
Contact information
Practice address
53 E LAKE MEAD PKWY, HENDERSON, NV 89015-5832
(702) 566-4133
Mailing address
5701 W CHARLESTON BLVD STE 103, LAS VEGAS, NV 89146-1256
(503) 476-5242
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
NULL
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
08/23/2023
Last updated
11/26/2023
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