Individual
ROBERT LYNN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
143 1/2 E MAIN, RIGBY, ID 83442
(208) 745-0400
(208) 745-5005
Mailing address
243 E FREMONT AVE, RIGBY, ID 83442-1410
(208) 745-0400
(208) 745-5005
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D3529
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806083700
—
ID
Enumeration date
08/30/2006
Last updated
06/22/2023
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