Individual
DR. EVAN BALE ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2660 WINDMILL PKWY, HENDERSON, NV 89074-3385
(702) 990-2960
Mailing address
6127 S RAINBOW BLVD STE 100, LAS VEGAS, NV 89118-3256
(702) 793-2182
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
7010
NV
Other
Enumeration date
01/30/2018
Last updated
03/17/2019
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