Individual
DR. MICHAEL ROY ELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
789 FARMINGTON AVE, BRISTOL, CT 06010-3919
(860) 583-6056
Mailing address
789 FARMINGTON AVE, BRISTOL, CT 06010-3919
(860) 583-6056
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
007856
CT
Other
Enumeration date
01/18/2007
Last updated
07/08/2007
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