Individual
MRS. EMILIE BONOVITCH ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
27 BRIGGS DR STE A, MANAKIN SABOT, VA 23103-2250
(804) 784-2386
Mailing address
8801 NESBIT FERRY LN, CHESTERFIELD, VA 23832-2133
(804) 349-8146
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
0402206328
VA
Other
Enumeration date
09/10/2021
Last updated
09/10/2021
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