Organization
CORBET K ELLISON DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CORBET K ELLISON DDS (OWNER)
(281) 741-5247
Entity
Organization
Contact information
Practice address
11233 SHADOW CREEK PKWY, SUITE 120, PEARLAND, TX 77584-7345
(281) 741-5247
(281) 741-5354
Mailing address
11233 SHADOW CREEK PKWY, SUITE 120, PEARLAND, TX 77584-7345
(281) 741-5247
(281) 741-5354
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
23589
TX
1223E0200X
Endodontics
26246
TX
1223G0001X
General Practice Dentistry
21095
TX
1223P0221X
Pediatric Dentistry
23589
TX
1223P0300X
Periodontics
10216
TX
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
23794
TX
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
25662
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
188083306
—
TX
Enumeration date
02/16/2011
Last updated
11/17/2011
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