Individual
DR. ELLIE SEVERANCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
404 N 4TH ST, ODESSA, MO 64076-1152
(573) 691-7700
Mailing address
728 HOBBS RD, JEFFERSON CITY, MO 65109-6817
(573) 691-7700
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2024019283
MO
Other
Enumeration date
06/07/2024
Last updated
06/07/2024
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