Individual
DR. ROBERT H. ELLIS III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
8905 TWO NOTCH RD, COLUMBIA, SC 29223-6367
(803) 788-9593
(803) 788-3123
Mailing address
8905 TWO NOTCH RD, COLUMBIA, SC 29223-6367
(803) 788-9593
(803) 788-3123
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3691
SC
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
10406
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ZA9724
—
SC
05
—
ZX3691
—
SC
Enumeration date
03/31/2006
Last updated
04/10/2023
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