Individual
DR. RICHARD D. ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
150 PROFESSIONAL CT., STE A, LAFAYETTE, IN 47905-5153
(765) 449-2757
(765) 449-2759
Mailing address
150 PROFESSIONAL CT., STE A, LAFAYETTE, IN 47905-5153
(765) 449-2757
(765) 449-2759
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7107
IN
Other
Enumeration date
09/22/2006
Last updated
07/08/2007
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