Individual
DR. DICK TRACY ELLISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1602 W JACKSON ST, MUNCIE, IN 47303
(765) 289-0236
Mailing address
1602 W JACKSON ST, MUNCIE, IN 47303
(765) 289-0236
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6592
IN
Other
Enumeration date
09/07/2006
Last updated
07/08/2007
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